Role of procalcitonin in identifying systemic inflammatory response syndrome and sepsis in acute-on-chronic liver failure and its impact on survival

Systemic inflammatory response syndrome (SIRS) and sepsis are commonly observed in patients with acute-on-chronic liver failure (ACLF). This study aimed to identify the presence of SIRS and sepsis in ACLF patients to assess their impact on patient survival and the role of procalcitonin (PCT) in identifying SIRS and sepsis. This prospective study was performed at a tertiary hospital in India from August 2023 to August 2024. Patients with ACLF according to the APASL classification were included in the study. These patients were assessed for the presence or absence of SIRS or sepsis at baseline and monitored until day 7, and clinical outcome was evaluated on day 28. A total of 135 patients with a median age of 44 years (IQR: 38–51) and a male predominance (98.5%, 133/135) were included in the study. Alcohol was the primary cause of ACLF in 88.1% of patients. Among these patients, SIRS was present in 59.2% of patients, while sepsis was present in 42.2%. Patients with SIRS and sepsis had significantly higher median MELD-Na, AARC, and CLIF-SOFA scores than those without SIRS and sepsis (p < 0.001). The 28-day mortality rate was greater in the SIRS group (60%) and sepsis group (59.64%) than in the non-SIRS group (p < 0.001). Furthermore, PCT was demonstrated as a significant independent predictor of mortality (OR 1.45, 95% CI: 1.12–1.89, p = 0.004). Sepsis and SIRS are common in ACLF patients and carry a high mortality risk. PCT measurement may be used to detect SIRS and sepsis in these patients early and can be used to guide prompt intervention to improve the outcome of these patients.