SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis
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.
KeywordsSIRS Severe alcoholic hepatitis AKI AKI progression
Systemic inflammatory response syndrome
Severe alcoholic hepatitis
Acute kidney injury
Acute kidney injury and network
Model for end-stage liver disease
Age, bilirubin, INR, and creatinine
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.
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