Sepsis is a major cause of death in ALF accounting for 24- 49% of death in Indian patients which is in fact more common than renal failure or GI bleed. We aimed to study the prevalence of sepsis in ALF and the role of prophylactic antibiotics in limiting the incidence of infections in ALF and improving related mortality. 46 patients of ALF were stratified into 2 main groups with SIRS>=2 and SIRS<2 on admission based on the number of SIRS components. Patients with SIRS>=2 were studied for the prevalence of sepsis in ALF. Patients with SIRS<2 were studied for the incidence of sepsis and the role of prophylactic antibiotics in ALF dividing them further into control group who received prophylactic antibiotics and the Test group who were given antibiotics only on worsening due to sepsis or there were evidence of infection. SIRS was documented regularly and on every episode of worsening. Prevalence of sepsis was studied by observing day1 infections. Role of prophylactic antibiotics was studied by documenting subsequent infections and related mortality in control group and comparing with the test group without prophylactic antibiotics. 70% of infected patients expressed more than 2 SIRS components whereas 27.3% infected patients never expressed more than 1 SIRS component. 50% infection rate was noted with expression of more than 2 SIRS components as compared to 14.3% who remained SIRS<2 without deterioration. Prevalence of sepsis was 64%. Mortality in the infected was 69% compared to 30% in the non infected. 71.4% infections with 40% related mortality was observed in the control group on prophylactic antibiotics whereas in the test group without antibiotic prophylaxis 75% infection were observed with 66.7% related mortality. This prospective evaluation points to SIRS being closely associated with infections. Use of prophylactic antibiotics may limit the incidence of infection and reduce sepsis related mortality in ALF.

Keywords: Sepsis; Prophylactic Antibiotics.