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