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Volume 41 Issue 8
Aug.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(8): 1620-1626

Clinical value of systemic inflammatory response index in patients with acute-on-chronic liver failure and co-infection

DOI: 10.12449/JCH250822

  • Department of Hepatology Medicine，The Fifth Medical Center of Chinese PLA General Hospital，Beijing 100039，China

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  • Corresponding author: SU Haibin， suhaibin302@163.com （ORCID： 0009-0000-2510-0006）
  • Received Date: 2024-12-21
  • Accepted Date: 2025-05-14
  • Published Date: 2025-08-25
    Abstract
  •   Objective  To investigate the application value of systemic inflammatory response index （SIRI） in patients with acute-on-chronic liver failure （ACLF） and co-infection.  Methods  A retrospective analysis was performed for the clinical data of 579 ACLF patients with co-infection who were diagnosed and treated in The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to March 2016， including demographic features， laboratory markers， and complications， and SIRI， Model for End-Stage Liver Disease （MELD） score， MELD combined with serum sodium concentration （MELD-Na） score， and Child-Pugh score were calculated. According to the results of follow-up on day 90， the patients were divided into survival group with 210 patients and death group with 369 patients. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test were used for comparison of categorical data between two groups. The binary logistic regression analysis was used to investigate the independent risk factors for 90-day death. The receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to assess the performance of SIRI， MELD-Na score， and Child-Pugh score in predicting the prognosis of ACLF patients with co-infection. The Kaplan-Meier survival analysis was performed based on the optimal cut-off value of SIRI.  Results  Among the 597 ACLF patients with co-infection， 384 （66.32%） had HBV-related ACLF and 114 （19.69%） had alcohol-related ACLF； as for the main infection sites， 316 （54.58%） had abdominal infection and 133 （22.97%） had pulmonary infection； the 90-day mortality rate was 63.73%. The multivariate logistic regression analysis showed that SIRI （odds ratio ［OR］=1.177， 95% confidence interval ［CI］： 1.117‍‍ ‍—‍ ‍1.239， P<0.05）， blood ammonia （OR=1.009， 95%CI： 1.001‍‍ ‍—‍ ‍1.018， P<0.05）， MELD-Na score （OR=1.047， 95%CI： 1.016‍‍ ‍—‍ ‍1.080， P<0.05）， Child-Pugh score （OR=1.351， 95%CI： 1.054‍‍ ‍—‍ ‍1.730， P<0.05）， age （OR=1.045， 95%CI： 1.021‍‍ ‍—‍ ‍1.070， P<0.05）， comorbidity with hepatic encephalopathy （OR=2.269， 95%CI： 1.305‍‍ ‍—‍ ‍3.946， P<0.05）， and comorbidity with acute kidney injury （OR=1.730， 95%CI： 0.990‍‍ ‍—‍ ‍3.023， P<0.05） were independent risk factors for 90-day death in ACLF patients with co-infection. The Pearson correlation analysis showed that SIRI was positively correlated with MELD-Na score （r=0.282， P<0.001） and Child-Pugh score （r=0.168， P<0.001）. SIRI， MELD-Na score， and Child-Pugh score had an AUC of 0.855， 0.734， and 0.690， respectively， in predicting 90-day death， and SIRI had a higher predictive efficiency than MELD-Na score and Child-Pugh score （Z=4.922 and 6.289， both P<0.001）， with a sensitivity of 76.7% and a specificity of 82.9%. In addition， SIRI combined with MELD-Na score or Child-Pugh score improved the predictive efficiency of MELD-Na score （0.854 vs 0.734， Z=6.899， P<0.001） and Child-Pugh score （0.858 vs 0.690， Z=8.725， P<0.001）. The patients with high SIRI （≥4.08） had a 90-day survival rate of 11.29% （36/319）， which was significantly lower than that in the patients with low SIRI （<4.08） （χ2 =225.24， P<0.001）.  Conclusion  SIRI is an independent risk factor for death in ACLF patients with co-infection and has a good clinical value in predicting prognosis， with the advantages of convenience and low costs.

     

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