Beyond traditional-the sick cirrhosis patient scores integrating cytokine and immune profiling for precision prognosis in hospitalized cirrhosis patients may help predict infection, ICU admission and long-term death post hospitalization.

Introduction: Inflammatory biomarkers and immune cell function may provide prognostic value beyond traditional severity scores in hospitalized cirrhosis patients. We aimed to characterize inflammatory and immune profiles to determine their predictive value for ICU admission, infection, and long-term mortality, and to develop novel scoring systems. Patients and methods: This retrospective observational cohort study enrolled 78 hospitalized cirrhosis patients. Comprehensive inflammatory profiling included 12 cytokines (multiplex immunoassay), flow cytometry immune markers, and acute phase reactants (e.g., procalcitonin). Outcome measures included ICU admission, infection, and death within 12-24 months. Multivariable logistic regression was used to identify independent predictors and develop three outcome-specific scoring systems. Results: The cohort had a mean MELD3 of 25.14; 38.5% required ICU admission, and 12-24-month mortality was 43.6%. Independent predictors for infection were procalcitonin (≥0.40 ng/mL), IL-6 (≥84 pg./mL), and creatinine (≥1.35 mg/dL) (AUC 0.74). ICU admission was predicted by hepatic encephalopathy, variceal bleeding, procalcitonin (≥0.40 ng/mL), and IL-6 (≥53.69 pg./mL) (AUC 0.82). Long-term mortality was predicted by ICU admission, hemoglobin (≤11.5 g/dL), EGF (≤2.9 pg./mL), and absolute nucleated cell count (≤3,600/μL) (AUC 0.821). Conclusion: Biomarkers reflecting systemic inflammation (IL-6, procalcitonin), immune paresis (low nucleated cell count), and failed regenerative capacity (low EGF) strongly predicted adverse outcomes. Integrating these markers into the proposed 'Sick Cirrhosis Patient Scores' may improve risk stratification, but these models require rigorous external validation.