SIRS criteria versus qSOFA score in patients with severe alcohol-related hepatitis

Severe alcohol-related hepatitis (sAH) is a potentially life-threatening complication of alcohol-related liver disease. SIRS criteria have been related to disease severity and may be a prognostic factor. Recently, qSOFA has been shown to be more prognostically accurate than SIRS in other inflammatory conditions. To determine whether qSOFA is a better prognostic score than SIRS criteria in sAH. We included 62 consecutive patients admitted for sAH, defined by modified Maddrey DF ≥ 32. MELD-Na, SIRS criteria and qSOFA score were calculated. Survival at 180 days was assessed. Twenty-four patients (38.7%) died after 180 days. Three or more SIRS criteria and two or more qSOFA criteria were associated with 180-day mortality (LR = 12.09, p = 0.001; LR = 4.81, p = 0.028, respectively). Patients with MELD-Na >30 points died during follow-up more frequently (LR = 5.997; p = 0.014). SIRS respiratory criterion (B = 5.113; p = 0.023) and qSOFA respiratory criterion (B = 5.985; p = 0.05), bilirubin (>10 mg/dL; LR = 5.43, p = 0.006), creatinine (>1 mg/dL; B = 5.885, p = 0.015) and hyponatraemia (LR= 5.75, p = 0.018) were associated with mortality. Cox Regression model revealed that only SIRS and MELD-Na were independent prognostic factors. SIRS criteria seem to be more useful for patients with sAH, as well as MELD-Na. In contrast, qSOFA has no independent prognostic value in patients with sAH.