Liu LN, Chang YF, Wang H. Correlations of three scoring systems with the prognosis of patients with liver cirrhosis complicated with sepsis syndrome. World J Gastrointest Surg 2025; 17(3): 99570 [DOI: 10.4240/wjgs.v17.i3.99570]
Corresponding Author of This Article
Li-Nan Liu, Department of Emergency, Beijing Ditan Hospital Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing 100102, China. 13911067330@163.com
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Liu LN designed the study, collected and analyzed data, and wrote the manuscript; Liu LN, Chang YF and Wang H participated in the study’s conception and data collection; Liu LN and Wang H participated in study design and provided guidance; All authors read and approved the final version.
Institutional review board statement: This study was approved by the Ethic Committee of Beijing Ditan Hospital Captital Medical University, No. 2024-05.
Informed consent statement: Due to the retrospective and de-identified nature of this study, written informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Nan Liu, Department of Emergency, Beijing Ditan Hospital Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing 100102, China. 13911067330@163.com
Received: October 23, 2024 Revised: December 2, 2024 Accepted: January 16, 2025 Published online: March 27, 2025 Processing time: 123 Days and 17.1 Hours
Abstract
BACKGROUND
Severe symptoms associated with sepsis syndrome (SS) are considered a severe threat, which not only increases therapeutic difficulty but also causes a prognostic mortality rate. However, at present, few related studies focused on the application of different score scales for disease and prognosis assessment in liver cirrhosis (LC) complicated with SS.
AIM
To determine the correlations of the model for end-stage liver disease (MELD), sequential organ failure assessment (SOFA), and modified early warning score (MEWS) points with the prognosis of patients with LC complicated with SS.
METHODS
This retrospective analysis included 426 LC cases from February 2019 to April 2022. Of them, 225 cases that were complicated with SS were assigned to the LC + SS group, and 201 simple LC cases were included in the LC group. Intergroup differences in MELD, SOFA, and MEWS scores were compared, as well as their diagnostic value for LC + SS. The correlations of the three scores with the prognosis of patients with LC + SS were further analyzed, as well as the related risk factors affecting patients’ outcomes, after the follow-up investigation.
RESULTS
MELD, SOFA, and MEWS scores were all higher in the LC + SS group vs the LC group, and their combined assessment for LC + SS revealed a diagnostic sensitivity and a specificity of 89.66% and 90.84%, respectively (P < 0.05). The LC + SS group reported 58 deaths, with an overall mortality rate of 25.78%. Deceased patients presented higher MELD, SOFA, and MEWS points than those who survived (P < 0.05). MELD, SOFA, and MEWS scores were determined by COX analysis as factors independently affecting the prognosis of patients with LC + SS (P < 0.05).
CONCLUSION
MELD, SOFA, and MEWS effectively diagnosed LC in patients complicated with SS, and they demonstrated great significance in assessing prognosis, which provides a reliable prognosis guarantee for patients with LC + SS. However, their assessment effects remain limited, which is worthy of further investigation by more in-depth and rigorous experimental analysis.
Core Tip: Severe symptoms and associated complications are crucial factors causing the death of patients with liver cirrhosis (LC). Among them, sepsis syndrome (SS) is a kind of severe threat, which not only increases therapeutic difficulty but also causes a prognostic mortality rate. This study confirmed the correlations of the model for end-stage liver disease, sequential organ failure assessment, and modified early warning score points with the prognosis of patients with LC complicated with SS.
Citation: Liu LN, Chang YF, Wang H. Correlations of three scoring systems with the prognosis of patients with liver cirrhosis complicated with sepsis syndrome. World J Gastrointest Surg 2025; 17(3): 99570
Hepatitis, an extremely high-prevalence progressive disease globally, affects over 20 million patients in China alone[1], with > 5 million of them eventually progressing to life-threatening liver cirrhosis (LC)[2]. Alcohol addiction, obesity, hypertriglyceridemia, diabetes, overwork, and health products have been considered to trigger LC[3]. The early manifestations of LC are insidious and perceptually invisible. Hence, most patients are diagnosed in the middle or even late stage when they seek medical treatment. Severe symptoms and associated complications are crucial factors causing the death of patients with LC[4]. Decompensated LC, characterized by easy immune system damage and severe infection occurrence, is currently one of the most prevalent LC types[5,6]. Among them, sepsis syndrome (SS) is a type of severe threat, which not only increases therapeutic difficulty but also causes a prognostic mortality rate of > 70%[7,8]. Active prevention, detection, and active treatment of SS in patients with LC are the keys to reducing the case fatality rate, which has long been the focus of clinical research[9,10].
The model for end-stage liver disease (MELD) scoring system, which has been widely utilized in the diagnosis and treatment of liver diseases, effectively predicts the short- and medium-term mortality of end-stage liver diseases[11]. The sequential organ failure assessment (SOFA) score is one of the clinical scoring methods for critical disease severity. SOFA is objective, simple, easy to obtain, and reliable, with a high application frequency in SS[12]. The modified early warning score (MEWS) is a simple assessment system for disease and prognosis evaluation. MEWS quickly, simply, and scientifically scores the severity of the disease and then predicts the risk of patient death based on the comprehensive score of patients’ heart rate, systolic blood pressure, respiratory rate, body temperature, and consciousness[13]. However, only a few related studies focused on the application of MELD, SOFA, and MEWS in LC complicated by SS (LC + SS) at present. This paper will provide a reliable theoretical basis for future clinical treatment by analyzing the correlation of the three scores with the prognosis of patients with LC + SS.
MATERIALS AND METHODS
General information
This study retrospectively analyzed 426 patients with LC who presented from February 2019 to April 2022, consisting of 225 patients with LC + SS (LC + SS group) and 201 cases with LC alone (LC group).
Eligibility criteria
All the enrolled cases present with clinical manifestations of LC and SS[14,15] and were diagnosed with LC (or LC + SS) after imaging and pathological assessment, with post-diagnosis treatment in our hospital, intact medical records, no adjuvant treatment before admission, and high compliance with the investigation work of our hospital. In contrast, those presenting with any of the following conditions were excluded from the study: Age of < 18 years; other tumors, or chronic, mental, or autoimmune diseases; hepatic and renal insufficiency; drug allergies; long-term bedridden and inability to take care of themselves due to physical disabilities; referrals; death during treatment.
Inspection methods
Body temperature, pulse, respiratory rate, etc., measurements were performed on all patients upon admission, and fasting venous blood (6 mL) was sampled for routine examinations, such as blood routine, liver function, and coagulation function, by the laboratory of our hospital. The assessment items included leukocytes, eosinophils, lymphocytes, C-reactive protein, procalcitonin (PCT), serum creatinine (SCr), uric acid, total bilirubin (TBiL), alanine transaminase (ALT), and aspartate aminotransferase (AST).
Scoring criteria
MELD was identified by referring to the MELD formula[16], namely, MELD = 3.8 × ln [TBiL (μmol/L)] × 0.059 + 11.2 × ln (international normalized ratio) + 9.6 × ln [SCr (μmol/L)] × 0.0113 + 6.4 × (0 for biliary or alcoholic LC, and 1 for others). SOFA score aimed to describe the occurrence and development of multiple organ dysfunction syndrome and assess the incidence, by recording the daily worst value, involving six organs, each with a score range of 0-4. The score was inversely correlated with the prognosis[17]. MEWS jointly evaluated the five physiological indicators of the patients, including consciousness, heart rate, body temperature, respiratory rate, and systolic blood pressure. Each item is scored 0-3, with the highest and lowest scores being 15 and 0 points, respectively[18].
Follow-up survey
The survival and mortality rates of patients during treatment and within one month after treatment completion were recorded.
Endpoints
Differences in MELD, SOFA, and MEWS were compared between the LC + SS group and the LC group, and the diagnostic value of the three for LC + SS was discussed. The correlations of the three scores with the prognosis of patients with LC + SS were further analyzed after the follow-up investigation, as well as the related risk factors affecting patient outcomes.
Statistical analysis
Statistical Package for the Social Sciences (SPSS) version 23.0 was used for statistical data analysis. Gender and other count data were expressed as (%) and analyzed with a χ2 test. The comparison was made by the independent sample t-test for quantitative data denoted by (mean ± SD). Diagnostic value was identified with receiver operating characteristic (ROC) curves. Binary Logistic regression analysis was conducted to obtain the joint value Log (P) for joint detection, after which ROC analysis was conducted. Related factors were determined with COX regression analysis. The presence of statistical significance was indicated with a P value of < 0.05.
RESULTS
Comparison of baseline data
We revealed no notable difference between the LC + SS group and the LC group when comparing age, sex, blood routine examination results, and other clinical baseline data between them (P > 0.05), indicating comparability (Table 1).
After investigation, MELD, SOFA, and MEWS of the LC + SS group were 18.93 ± 10.05, 6.32 ± 3.88, and 3.47 ± 1.94, respectively, all of which were lower as compared with the LC group of 15.23 ± 9.51, 4.98 ± 1.85, and 2.31 ± 1.33 (P < 0.05; Figure 1).
Figure 1 Comparison of model for end-stage liver disease, sequential organ failure assessment and modified early warning scores.
A: Comparison of model for end-stage liver disease (MELD) scores between liver cirrhosis (LC) + sepsis syndrome (SS) group and LC group; B: Comparison of sequential organ failure assessment scores between LC + SS group and LC group; C: Comparison of modified early warning scores between LC + SS group and LC group. aP < 0.05; MELD: End-stage liver disease; SOFA: Sequential organ failure assessment; MEWS: Modified early warning score; LC: Liver cirrhosis; SS: Sepsis syndrome.
Effects of MELD, SOFA, and MEWS on predicting SS in patients with LC
ROC analysis revealed that the sensitivity and specificity for predicting SS in patients with LC were 75.56% and 42.29% in MELD of > 12.09 (P < 0.05), 31.56% and 93.53% in SOFA of > 7.50 (P < 0.05), and 94.22% and 27.36% in MEWS of > 1.50 (P < 0.05), respectively. A binary Logistic regression analysis was then conducted to obtain a joint detection formula of the three scores using MELD, SOFA, and MEWS as covariates, and whether the patient develops LC or not as the dependent variable: Log (P) = -1.718 + (0.038 × MELD) + (0.021 × SOFA) + (0.388 × MEWS). Subsequently, ROC analysis of Log (P) of the two groups revealed that the sensitivity and specificity for predicting SS in patients with LC were 33.78% and 93.03%, respectively, in Log (P) of > 0.68 (P < 0.05; Figure 2).
Figure 2 Impacts of model for end-stage liver disease, sequential organ failure assessment and modified early warning scores on predicting sepsis syndrome in liver cirrhosis patients.
A: Receiver operating characteristic (ROC) curve of model for end-stage liver disease (MELD) for predicting sepsis syndrome (SS) in liver cirrhosis (LC) patients; B: ROC curve of sequential organ failure assessment (SOFA) for predicting SS in LC patients; C: ROC curve of modified early warning score (MEWS) for predicting SS in LC patients; D: ROC curve of MELD, SOFA and MEWS combined for predicting SS in LC patients. AUC: Area under curve; LC: Liver cirrhosis; SS: Sepsis syndrome.
Evaluation effect of MELD, SOFA, and MEWS on prognosis
The LC + SS group reported 58 deaths, with an overall mortality rate of 25.78%. Cases were further assigned to either the dead or the surviving group based on their survival. Inter-group comparisons of MELD, SOFA, and MEWS revealed higher scores in the dead group vs the surviving group (P < 0.05). Subsequently, ROC analysis was conducted, indicating sensitivity and specificity for predicting patient death of 84.48% and 79.04% in MDLD of > 19.91 (P < 0.05), 86.20% and 81.44% in SOFA of > 6.50 (P < 0.05), and 68.97% and 73.65% in MDLD of > 3.50 (P < 0.05), respectively. While the Log (P) = -4.906 + (0.064 × MELD) + (0.364 × SOFA) + (-0.053 × MEWS) of the combined tests of the threescores demonstrated a sensitivity of 89.66% and a specificity of 90.84% in predicting patient death (P < 0.05; Figure 3).
Figure 3 Evaluation effect of model for end-stage liver disease, sequential organ failure assessment and modified early warning scores on prognosis.
A: Comparison of model for end-stage liver disease (MELD) scores between dead patients and surviving patient; B: Comparison of sequential organ failure assessment (SOFA) scores between dead patients and surviving patient; C: Comparison of modified early warning score (MEWS) between dead patients and surviving patient; D: Receiver operating characteristic (ROC) curve of MELD in predicting the death of liver cirrhosis (LC) patients with sepsis syndrome (SS); E: ROC curve of SOFA in predicting the death of LC patients with SS; F: ROC curve of MEWS in predicting the death of LC patients with SS; G: ROC curve of MELD, SOFA and MEWS combined in predicting the death of LC patients with SS. aP < 0.05; MELD: End-stage liver disease; SOFA: Sequential organ failure assessment; MEWS: Modified early warning score; LC: Liver cirrhosis; SS: Sepsis syndrome.
Univariate analysis of prognosis in patients with LC + SS
Univariate analysis revealed no statistical difference in age, gender, etc., between groups (P > 0.05), indicating that none of the above indicators were single factors affecting the prognosis of patients with LC + SS. However, higher white blood cells, pulse, TBiL, etc., were identified in the dead group compared with the surviving group, with lower respiratory rate, PTA, etc., than the survival group (P < 0.05), indicating the role of these scores as single factors affecting outcomes of patients with LC + SS (Table 2).
Table 2 Univariate analysis of prognosis in liver cirrhosis + sepsis syndrome patients.
Surviving patient (n = 167)
Dead patients (n = 58)
t/χ2
P value
Age (years)
53.58 ± 12.32
58.76 ± 11.46
2.807
0.005
Body temperature (°C)
37.75 ± 1.09
37.19 ± 0.96
3.472
< 0.001
The pulse (times/minute)
93.20 ± 17.13
102.79 ± 16.46
3.710
< 0.001
Respiratory rate (times/minute)
20.29 ± 2.88
23.36 ± 5.77
5.256
< 0.001
White blood cells (× 109/L)
8.55 ± 6.97
12.60 ± 8.62
3.578
< 0.001
Neutrophils (× 109/L)
7.61 ± 8.91
10.89 ± 7.95
2.481
0.014
Eosinophils (%)
0.05 ± 0.07
0.03 ± 0.06
1.942
0.053
Lymphocytes (× 109/L)
0.86 ± 0.93
1.01 ± 1.14
0.996
0.320
Hb (g/L)
96.79 ± 27.74
94.43 ± 27.33
0.560
0.576
PLT (× 109/L)
82.00 ± 77.24
82.07 ± 63.14
0.006
0.995
PCT (ng/L)
11.27 ± 5.40
19.39 ± 31.37
3.223
0.002
CRP (mg/L)
57.55 ± 65.80
75.74 ± 63.35
1.831
0.068
LaC (mmol/L)
2.67 ± 2.42
6.08 ± 4.07
7.632
< 0.001
ALT (U/L)
40.60 ± 100.66
188.87 ± 511.08
3.569
< 0.001
AST (U/L)
75.66 ± 273.75
344.20 ± 898.21
3.442
< 0.001
ALB (g/L)
29.99 ± 5.20
27.55 ± 6.18
2.928
0.004
TBiL (μmol/L)
78.35 ± 93.75
166.86 ± 139.29
5.415
< 0.001
PTA (%)
54.58 ± 18.71
33.35 ± 17.58
7.559
< 0.001
Creatinine (μmol/L)
94.31 ± 71.71
215.54 ± 265.12
5.388
< 0.001
Gender
0.304
0.581
Male/female
127/40
42/16
Liver cancer
1.364
0.243
None/have
129/38
49/9
Hypertension
6.224
0.013
None/have
136/31
38/20
Diabetes
3.777
0.052
None/have
138/29
41/17
Coronary heart disease
9.068
0.003
None/have
159/8
48/10
Chronic renal insufficiency
7.822
0.005
None/have
158/9
48/10
Chronic liver failure
47.640
< 0.001
None/have
116/51
10/48
Acute liver failure
59.900
< 0.001
None/have
151/16
24/34
Acute renal failure
81.780
< 0.001
None/have
138/29
10/48
Respiratory failure
67.210
< 0.001
None/have
160/7
29/29
Acute heart failure
28.090
< 0.001
None/have
161/6
42/16
Septic shock
115.900
< 0.001
None/have
144/23
5/53
Hepatic encephalopathy
47.600
< 0.001
None/have
136/31
19/39
Upper gastrointestinal bleeding
6.939
0.008
None/have
128/39
34/24
Multivariate analysis of prognosis in patients with LC + SS
The univariate indexes in the above analysis were assigned and input into SPSS for multivariate COX analysis. MELD, SOFA, MEWS, PCT, presence of chronic liver failure, acute liver failure, acute renal failure, respiratory failure, acute heart failure, and septic shock (P < 0.05) were considered independent factors affecting the prognosis of patients with LC + SS but not age, body temperature, respiratory rate, etc., (P > 0.05; Tables 3 and 4).
Table 4 Multivariate analysis of prognosis in liver cirrhosis + sepsis syndrome patients.
Factors
Β
SE
χ2
P value
OR
95%CI
Age (years)
0.225
0.114
3.942
> 0.05
1.241
1.010-1.562
Body temperature (°C)
0.342
0.263
1.714
> 0.05
1.415
0.842-2.364
The pulse (times/minute)
0.169
0.315
0.281
> 0.05
1.180
0.634-2.094
Respiratory rate (times/minute)
0.442
0.216
4.062
> 0.05
1.612
1.031-2.424
White blood cells (× 109/L)
0.176
0.311
0.342
> 0.05
1.194
0.642-2.191
Neutrophils (× 109/L)
0.323
0.164
4.061
> 0.05
1.394
1.004-1.924
PCT (ng/L)
0.340
0.142
5.584
< 0.05
1.401
1.061-1.867
LaC (mmol/L)
0.226
0.114
3.984
> 0.05
1.264
1.001-1.569
ALT (U/L)
1.642
0.342
3.032
> 0.05
4.061
1.942-8.662
AST (U/L)
0.681
0.406
2.716
> 0.05
1.942
0.884-4.621
ALB (g/L)
1.031
0.384
3.621
> 0.05
2.841
1.334-6.256
TBiL (μmol/L)
0.122
0.064
4.103
> 0.05
1.421
1.224-1.618
PTA (%)
0.143
0.043
6.262
> 0.05
1.246
1.081-2.621
Creatinine (μmol/L)
0.257
0.041
3.627
> 0.05
1.581
1.413-2.782
MELD scores
0.327
0.034
46.121
< 0.001
1.815
1.224-2.493
SOFA scores
-0.218
0.036
34.861
< 0.001
1.712
1.344-2.483
MEWS scores
0.912
0.196
24.312
< 0.001
2.493
1.731-3.562
Hypertension
0.612
0.241
4.311
> 0.05
1.814
1.184-2.886
Coronary heart disease
0.381
0.181
4.371
> 0.05
1.460
1.013-2.262
Chronic renal insufficiency
0.348
0.181
3.861
> 0.05
1.693
1.482-1.983
Chronic liver failure
-0.651
0.191
17.593
< 0.001
1.51
1.340-1.798
Acute liver failure
0.284
0.114
6.412
0.010
1.381
1.068-1.663
Acute renal failure
3.816
0.342
70.161
< 0.001
27.062
12.811-60.347
Respiratory failure
-0.421
0.192
15.010
< 0.001
1.663
1.452-2.958
Acute heart failure
0.263
0.234
10.068
< 0.001
1.061
1.020-1.683
Septic shock
0.623
0.172
35.061
< 0.001
1.527
1.384-1.730
Hepatic encephalopathy
-0.311
0.142
4.621
> 0.05
0.721
0.516-0.972
Upper gastrointestinal bleeding
0.612
0.172
3.284
> 0.05
1.554
1.396-1.768
DISCUSSION
At present, an independent scoring system to predict the prognosis of patients co-infected with LC with infection remains lacking. The correlation of MELD, SOFA, and MEWS with LC or other organ failure has been repeatedly verified[19-21], but their employment in LC + SS assessment remains rare. Therefore, this study demonstrates important reference significance for future clinical prevention of SS and prognosis evaluation of patients by investigating the correlation of MELD, SOFA, and MEWS with LC + SS.
This study first conducted inter-group comparisons in terms of MELD, SOFA, and MEWS. It revealed higher MELD, SOFA, and MEWS in the LC + SS group than in the LC group, indicating a certain correlation between the three scores and SS in patients with LC. Patients with LC generally present with multi-organ functional disturbance and multiple organ failure. Additionally, infection is the leading cause of complications as well as the primary reason for death, thereby significantly increasing the mortality of co-infected patients[22]. The prognosis judgment of infection involves not only the liver itself and the disease state but also the degree of infection. Therefore, early warning, as well as early diagnosis and intervention, which have always been a hot issue, are crucial[23,24]. In this study, we conducted ROC analysis and revealed that the MELD, SOFA, and MEWS were all of favorable diagnostic value in diagnosing LC in patient with SS, with the sensitivity and specificity of their combined tests being 89.66% and 90.84%, respectively, which has extremely important reference significance for LC + SS that lacks effective assessment scheme at present. Furthermore, the three scores were considered factors that independently affect the prognosis of patients with LC + SS in the follow-up of prognosis. The prognostic survival curve and ROC indicate that the three scores demonstrated good diagnostic value for prognostic death, with their increased assessment results, exhibiting an increased risk of death in patients. Therefore, in the future, MELD, SOFA, and MEWS are expected to effectively assess the prognosis of patients with LC + SS in an early stage to enable timely intervention, thereby providing a more reliable guarantee for improving patient outcomes. Previous studies[25-28] revealed a single scoring scale to have some clinical application value. In particular, individual SOFA component predictors were useful in identifying in-hospital mortality or prolonged intensive care unit stay, which may help determine a subset of patients with sepsis who are at increased risk for adverse outcomes. More importantly, the results indicate that individual SOFA components, although independently related to outcomes, do not exhibit similar predictive power for all organ dysfunction[26]. The MEWS has been considered a reliable and easy-to-use first-time patient assessment score. It helps in the management of patients before and during hospitalization[27]. However, these previous studies were all focused on a single scale. In contrast to our study, we have combined the three scales, although we also revealed that the evaluation based on the three scores demonstrated the following limitations: (1) The three scores are too subjective, which may cause misdiagnosis and missed diagnosis; (2) Multiple organ failure and other basic diseases are prevalent in patients with LC + SS, and MELD, SOFA, and MEWS scores may be influenced by other factors, causing a final result not so specific for SS assessment; and (3) Detailed segmentation of score results remains lacking, causing large differences in prognosis among patients with consistent scoring results. Given the above, much room for improvement remains in the assessment of LC + SS by MELD, SOFA, and MEWS in the future. In particular, the weight of each score can be increased, more detailed evaluation criteria can be developed for the pathological manifestations of LC, and some objective indicators can be added to assist in assessing disease progression.
This study has many limitations to be addressed. First, this is a retrospective analysis with a limited number of cases; thus, some errors are unavoidable. Second, as aforementioned, we need to screen the selected cases and reduce other factors that may affect the scoring results (such as other organ failure) to improve the accuracy of the experimental results. Third, patients with LC with other complications were not included in the sample to observe whether the presence of other complications would affect the prediction accuracy. Fourth, the sample size of the study was too small to further verify the current conclusion due to the retrospective and single-center study design. Finally, we need to follow up with the patients for a longer time to further analyze the assessment effect of MELD, SOFA, and MEWS on patients’ long-term prognosis. Therefore, a well-designed, large sample size, multi-center with long-term follow-up study is warranted for further investigation.
CONCLUSION
Collectively, MELD, SOFA, and MEWS effectively diagnose patients with LC complicated with SS and play an excellent role in assessing the prognosis of patients, thereby providing reliable prognosis guarantee for patients with LC + SS. However, their evaluation effects still have some limitations, which is worthy of further investigation by more in-depth and rigorous experimental analysis.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade B, Grade C
P-Reviewer: Cariani E; Caturelli E S-Editor: Li L L-Editor: A P-Editor: Wang WB
Fukui H, Saito H, Ueno Y, Uto H, Obara K, Sakaida I, Shibuya A, Seike M, Nagoshi S, Segawa M, Tsubouchi H, Moriwaki H, Kato A, Hashimoto E, Michitaka K, Murawaki T, Sugano K, Watanabe M, Shimosegawa T. Evidence-based clinical practice guidelines for liver cirrhosis 2015.J Gastroenterol. 2016;51:629-650.
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Herwanto V, Shetty A, Nalos M, Chakraborty M, McLean A, Eslick GD, Tang B. Accuracy of Quick Sequential Organ Failure Assessment Score to Predict Sepsis Mortality in 121 Studies Including 1,716,017 Individuals: A Systematic Review and Meta-Analysis.Crit Care Explor. 2019;1:e0043.
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Moraes PAD, Tannuri ACA, Rios LM, Paes VR, Gonçalves JO, Serafini S, Tannuri U. Sepsis and cirrhosis in growing animals: description of a new experimental model and its pathological and immunological reliability.Clinics (Sao Paulo). 2020;75:e1858.
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