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Digestive Diseases and Sciences

, Volume 61, Issue 3, pp 920–929 | Cite as

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

  • R. Maiwall
  • S. S. Chandel
  • Z. Wani
  • S. Kumar
  • S. K. Sarin
Original Article

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.

Keywords

SIRS Severe alcoholic hepatitis AKI AKI progression 

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

Notes

Compliance with ethical standards

Conflict of interest

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.

Supplementary material

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Supplementary material 1 (DOCX 14 kb)
10620_2015_3921_MOESM2_ESM.docx (12 kb)
Supplementary material 2 (DOCX 12 kb)
10620_2015_3921_MOESM3_ESM.docx (12 kb)
Supplementary material 3 (DOCX 12 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • R. Maiwall
    • 1
  • S. S. Chandel
    • 1
  • Z. Wani
    • 1
  • S. Kumar
    • 2
  • S. K. Sarin
    • 1
  1. 1.Department of HepatologyInstitute of Liver and Biliary Sciences (ILBS)New DelhiIndia
  2. 2.Department of Clinical HematologyCommand Hospital [Eastern Command]KolkataIndia

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