Background & Aims An algorithm including Sepsis‐3 criteria and quick Sequential Organ Failure Assessment (qSOFA) was recently proposed to predict severity of infection in cirrhosis. However, its applicability among patients without a baseline SOFA available for Sepsis‐3 definition is unknown. We sought to investigate the applicability and prognostic value of qSOFA and Sepsis‐3 criteria in patients with cirrhosis hospitalised for bacterial infections, without pre‐hospitalisation SOFA. Methods In this cohort study, 164 patients were followed up to 30 days. Data collection, including the prognostic models, was performed at admission and at day‐3. Results All patients fulfilled Sepsis‐3 criteria (admission SOFA ≥ 2) and, therefore, admission Sepsis‐3 was not included in further analysis. Admission qSOFA was an independent predictor of survival (HR = 2.271, P = 0.015). For patients initially classified as high risk by qSOFA, Chronic Liver Failure ‐ Sequential Organ Failure Assessment (CLIF‐SOFA) was the only prognostic predictor. Among patients initially classified as low risk by qSOFA, the following parameters evaluated at day‐3 were independent predictors of survival: qSOFA, acute‐on‐chronic liver failure, and Child‐Pugh classification. Although not independently related to survival, Sepsis‐3 criteria at day‐3 was associated with lower 30‐day survival in Kaplan‐Meier analysis (66% vs 85%, P = 0.008). However, prognosis was better predicted by day‐3 qSOFA, with 30‐day Kaplan‐Meier survival probability of 88% when qSOFA < 2 and 24% among those with qSOFA ≥ 2. Conclusion Sepsis‐3 criteria evaluated at admission are very limited in infected patients with cirrhosis without baseline SOFA. qSOFA was independently related to survival and appears to be a valuable tool for determining severity of infection and to follow patients initially classified as low risk.

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Background. Although recently challenged, systemic inflammatory response syndrome (SIRS) criteria are still commonly used in daily practice to define sepsis. However, several factors in liver cirrhosis may negatively impact its prognostic ability. Goals. To investigate the factors associated with the presence of SIRS, the characteristics of SIRS related to infection, and its prognostic value among patients hospitalized for acute decompensation of cirrhosis. Study. In this cohort study from two tertiary hospitals, 543 patients were followed up, up to 90 days. Data collection, including the prognostic models, was within 48 hours of admission. Results. SIRS was present in 42.7% of the sample and was independently associated with upper gastrointestinal bleeding (UGB), ACLF, infection, and negatively related to beta-blockers. SIRS was associated with mortality in univariate analysis, but not in multiple Cox regression analysis. The Kaplan–Meier survival probability of patients without SIRS was 73.0% and for those with SIRS was 64.7%. The presence of SIRS was not significantly associated with mortality when considering patients with or without infection, separately. Infection in SIRS patients was independently associated with Child-Pugh C and inversely related to UGB. Among subjects with SIRS, mortality was independently related to the presence of infection, ACLF, and Child-Pugh C. Conclusions. SIRS was common in hospitalized patients with cirrhosis and was of no prognostic value, even in the presence of infection.

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