C-Reactive protein predicts short-term mortality in patients with cirrhosis

Background & Aims We aimed at improving prediction of short-term mortality in cirrhotic inpatients by evaluating C-reactive protein (CRP) as a surrogate marker of systemic inflammatory response syndrome (SIRS). Methods One-hundred and forty-eight consecutive cirrhotic patients with Child-Pugh score ⩾B8 and without hepatocellular carcinoma were prospectively included and followed for 182days. The primary end point was 6-month survival. Results Main baseline characteristics were as follows: alcoholic liver disease in 88.5%; bacterial infection in 37%; hepatorenal syndrome in 7% of cases. CRP range was 1–240mg/L (median 26mg/L); 42 patients (28.4%) had SIRS as defined by ACCP/SCCM-criteria. CRP levels were higher in patients with SIRS (50 vs. 21mg/L; p vs. 27mg/L; p vs. 32mg/L, p =0.049). Forty-two patients died within the first 6months of follow-up. Short-term mortality was associated with extrahepatic co-morbidities ( p =0.002), high MELD score ( p = 0.67), renal failure ( p =0.008), elevated blood lactates ( p p =0.003; AUROC = 0.63; best cut-off value at 29mg/L). Among patients with baseline CRP ⩾29mg/L, 32 still had CRP ⩾29mg/L at day 15 (group A). Group A was associated with 6-month mortality in the overall population ( p p p =0.006), and CRP level (group A) (HR=2.73; 95% CI: 1.41–5.26; p =0.003). The performance of the three variables taken together for predicting death was 0.80 (AUROC). Conclusions In Child-Pugh score ⩾B8 cirrhotic patients, persistent CRP levels ⩾29mg/L predicted short-term mortality independently of age, MELD, and co-morbidities, and better than infection or clinically-assessed SIRS.