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



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).


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


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


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).


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.


SIRS Severe alcoholic hepatitis AKI AKI progression 



Systemic inflammatory response syndrome


Hepatic encephalopathy


Severe alcoholic hepatitis


Acute kidney injury


Acute kidney injury and network


Model for end-stage liver disease


Age, bilirubin, INR, and creatinine


Discriminant function


Hepatorenal syndrome


Spontaneous bacterial peritonitis


Renal replacement therapy


Compliance with ethical standards

Conflict of interest



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


  1. 1.
    Lucey MR, Mathurin P, Morgan TR. Alcoholic hepatitis. N Engl J Med. 2009;360:2758–2769.CrossRefPubMedGoogle Scholar
  2. 2.
    Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut. 2011;60:255–260.CrossRefPubMedGoogle Scholar
  3. 3.
    Belcher JM, Garcia-Tsao G, Sanyal AJ, et al. Association of AKI with mortality and complications in hospitalized patients with cirrhosis. Hepatology. 2013;57:753–762.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Altamirano J, Fagundes C, Dominguez M, et al. Acute kidney injury is an early predictor of mortality for patients with alcoholic hepatitis. Clin Gastroenterol Hepatol. 2012;10:65–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Michelena J, Altamirano J, Abraldes JG, et al. Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis. Hepatology. 2015;62:762–772.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Kubes P, Mehal WZ. Sterile inflammation in the liver. Gastroenterology. 2012;143:1158–1172.CrossRefPubMedGoogle Scholar
  7. 7.
    Potts JR, Goubet S, Heneghan MA, Verma S. Determinants of long-term outcome in severe alcoholic hepatitis. Aliment Pharmacol Ther. 2013;38:584–595.CrossRefPubMedGoogle Scholar
  8. 8.
    Dominguez M, Rincón D, Abraldes JG, et al. A new scoring system for prognostic stratification of patients with alcoholic hepatitis. Am J Gastroenterol. 2008;103:2747–2756.CrossRefPubMedGoogle Scholar
  9. 9.
    Wong F, Nadim MK, Kellum JA, et al. Working party proposal for a revised classification system of renal dysfunction in patients with cirrhosis. Gut. 2010;60:702–709.CrossRefGoogle Scholar
  10. 10.
    American College of Chest Physicians/Society of Critical Care. Medicine Consensus. Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–874.CrossRefGoogle Scholar
  11. 11.
    Angeli P, Tonon M, Pilutti C, Morando F, Piano S. Sepsis-induced acute kidney injury in patients with cirrhosis. Hepatol Int. 2015.Google Scholar
  12. 12.
    Barreto R, Fagundes C, Guevara M, et al. Type-1 hepatorenal syndrome associated with infections in cirrhosis: natural history, outcome of kidney function, and survival. Hepatology. 2014;59:1505–1513.CrossRefPubMedGoogle Scholar
  13. 13.
    Rodríguez E, Elia C, Solà E, et al. Terlipressin and albumin for type-1 hepatorenal syndrome associated with sepsis. J Hepatol. 2014;60:955–961.CrossRefPubMedGoogle Scholar
  14. 14.
    Francoz C, Durand F. Type-1 hepatorenal syndrome in patients with cirrhosis and infection vs. sepsis-induced acute kidney injury: What matters? J Hepatol. 2014;60:907–909.CrossRefPubMedGoogle Scholar
  15. 15.
    Shah N, Mohamed FE, Jover-Cobos M, et al. Increased renal expression and urinary excretion of TLR4 in acute kidney injury associated with cirrhosis. Liver Int. 2013;33:398–409.CrossRefPubMedGoogle Scholar
  16. 16.
    Barreto R, Elia C, Solà E, Moreira R, Ariza X, Rodríguez E et al. Urinary neutrophil gelatinase-associated lipocalin predicts kidney outcome and death in patients with cirrhosis and bacterial infections. J Hepatol. 2014. doi:  10.1016/j.jhep.2014.02.023
  17. 17.
    Louvet A, Wartel F, Castel H, et al. Infection in patients with severe alcoholic hepatitis treated with steroids: early response to therapy is the key factor. Gastroenterology. 2009;137:541–548.CrossRefPubMedGoogle Scholar
  18. 18.
    Hmoud BS, Patel K, Bataller R, Singal AK. Corticosteroids and occurrence of and mortality from infections in severe alcoholic hepatitis: a meta-analysis of randomized trials. Liver Int. 2015. doi: 10.1111/liv.12939.
  19. 19.
    Fagundes C, Barreto R, Guevara M, et al. A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis. J Hepatol. 2013;59:474–481.CrossRefPubMedGoogle Scholar
  20. 20.
    Thabut D, Massard J, Gangloff A, et al. Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure. Hepatology. 2007;46:1872–1882.CrossRefPubMedGoogle Scholar
  21. 21.
    Thursz MR, Richardson P, Allison M, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med. 2015;372:1619–1628.CrossRefPubMedGoogle Scholar
  22. 22.
    Altamirano J, Miquel R, Katoonizadeh A, et al. A histologic scoring system for prognosis of patients with alcoholic hepatitis. Gastroenterology. 2014;146:1231-9.e1-6. doi: 10.1053/j.gastro.2014.01.018.CrossRefPubMedGoogle Scholar
  23. 23.
    Gao B, Shah VH. Combination therapy: New hope for alcoholic hepatitis? Clin Res Hepatol Gastroenterol. 2015. doi: 10.1016/j.clinre.2015.05.008.

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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