The systemic inflammatory response syndrome (SIRS) in acute liver failure (
ALF), in which infection is common, has not been studied. In this study, SI
RS components were recorded on admission and during episodes of infection,
in 887 ALF patients admitted to a single center during an 11-year period. O
verall, 504 (56.8%) patients manifested a SIRS during their illness, with a
maximum of 1, 2, and 3 concurrent SIRS components in 166, 238, and 100 pat
ients, respectively. In 353 (39.8%) patients who did not become infected, a
SIRS on admission was associated with a more critical illness, subsequent
worsening of encephalopathy, and death. infected patients more often develo
ped a SIRS and one of greater magnitude. The magnitude of the SIRS in 273 p
atients with bacterial infection correlated with mortality, being 16.7%, 28
.4%, 41.2%, and 64.7% in patients with 0, 1, 2, and 3 maximum concurrent SI
RS components, respectively. Similar correlations with mortality were seen
for SIRS associated with fungal infection, bacteremia, and bacterial chest
infection. Fifty-nine percent of patients with severe sepsis died, as did 9
8% of those with septic shock. A significant association was found between
progressive encephalopathy and infection. Infected patients with progressiv
e encephalopathy manifested more SIRS components than other infected patien
ts. For patients with a SIRS, the proportions of infected and noninfected p
atients manifesting worsening encephalopathy were similar. In ALF, the SIRS
, whether or not precipitated by infection, appears to be implicated in the
progression of encephalopathy, reducing the chances of transplantation and
conferring a poorer prognosis.