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SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis

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Abstract

Background

Systemic inflammatory response syndrome (SIRS) is associated with an increased risk of hepatic encephalopathy, renal failure, and poor outcome in patients with cirrhosis; however, there is a paucity of studies on this entity for severe alcoholic hepatitis (SAH).

Aim

To evaluate SIRS at baseline as a predictor of development of acute kidney injury (AKI) and mortality in patients with SAH.

Methods

Consecutive in-patients with SAH (discriminant function ≥ 32) without AKI at baseline were followed up for the development and progression of AKI (AKIN criteria).

Results

Of the 365 patients (mean age 45.5 ± 9.5, 356 males), SIRS at baseline was present in 236 (64.6 %). AKI developed in 122 (33.4 %), of which 50 (40.9 %) had progression of AKI. SIRS was associated with bacterial infections in 96 (40.6 %) and in 140 (59.3 %) occurred in the absence of proven infection microbiologically. The presence of SIRS predicted both AKI development (p < 0.001, OR 2.9, 95 % CI 1.7–4.8) and AKI progression (p = 0.002, OR 3.27, 95 % CI 1.48–7.21). Resolution of AKI also had a significant inverse association with SIRS (p = 0.001). High MELD score (p = 0.002, HR 1.1, 95 % CI 1.02–1.09), in-hospital progression of AKI (p = 0.04, HR 1.54, 95 % CI 1.003–2.38), and SIRS (p = 0.004, HR 1.98, 95 % CI 1.25–3.1) were significant predictors of 90-day mortality (model 1), while high MELD score (p < 0.001, HR 1.1, 95 % CI 1.04–1.12) and bacterial infections (p = 0.001, HR 1.8, 95 % CI 1.27–2.6) were independent predictors of mortality in the second multivariate model (model 2).

Conclusion

SIRS at admission predicts both the development of AKI and 90-day mortality in patients with SAH. This could definitely have a therapeutic and prognostic implication.

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Abbreviations

SIRS:

Systemic inflammatory response syndrome

HE:

Hepatic encephalopathy

SAH:

Severe alcoholic hepatitis

AKI:

Acute kidney injury

AKIN:

Acute kidney injury and network

MELD:

Model for end-stage liver disease

ABIC:

Age, bilirubin, INR, and creatinine

DF:

Discriminant function

HRS:

Hepatorenal syndrome

SBP:

Spontaneous bacterial peritonitis

RRT:

Renal replacement therapy

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Authors and Affiliations

  1. Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India

    R. Maiwall, S. S. Chandel, Z. Wani & S. K. Sarin

  2. Department of Clinical Hematology, Command Hospital [Eastern Command], Kolkata, India

    S. Kumar

Authors
  1. R. Maiwall
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  2. S. S. Chandel
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  3. Z. Wani
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  4. S. Kumar
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  5. S. K. Sarin
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Corresponding author

Correspondence to S. K. Sarin.

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None.

Disclosure

RM and SKS made the study concept and design; RM and SSC contributed to acquisition of data, analysis, and interpretation of data; RM and SKS drafted the manuscript; SKS critically revised the manuscript for important intellectual content; RM and SK performed statistical analysis.

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Maiwall, R., Chandel, S.S., Wani, Z. et al. SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis. Dig Dis Sci 61, 920–929 (2016). https://doi.org/10.1007/s10620-015-3921-4

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  • DOI: https://doi.org/10.1007/s10620-015-3921-4

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