SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis
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 ba...
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| Veröffentlicht in: | Digestive diseases and sciences 2016-03, Vol.61 (3), p.920-929 |
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| creator | Maiwall, R. Chandel, S. S. Wani, Z. Kumar, S. Sarin, S. K. |
| description | 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
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| doi_str_mv | 10.1007/s10620-015-3921-4 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1776649310</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A712938576</galeid><sourcerecordid>A712938576</sourcerecordid><originalsourceid>FETCH-LOGICAL-c542t-2d668f26084ee90a081c92bb49c9c572bc6f2db6632ff056b99873431f1552d63</originalsourceid><addsrcrecordid>eNqNkstu1DAYhS0EokPhAdggS2zYpLWd-LaMWmBGFLViYG05jt26SuJge0Dt0-NoCgVUJOSFb985-o90AHiJ0RFGiB8njBhBFcK0qiXBVfMIrDDldUUoE4_BCmFWzhizA_AspWuEkOSYPQUHhDUcCSZW4Ha7-bSFOsO2H31KPkxwk6CGF9H23uQQYXCw_bCBp_abHcI82ilDPfXwY4hZDz7fQD_BdUizX663tocXOvtCJfjd5yu4LbpoYTuYcBUGb-DazgXIPj0HT5wekn1xtx-CL-_efj5ZV2fn7zcn7VllaENyRXrGhCMMicZaiTQS2EjSdY000lBOOsMc6TvGauIcoqyTUvC6qbHDlBZxfQje7H3nGL7ubMqqJDV2GPRkwy4pzDljjawx-g-UccQEogv6-i_0OuziVIIshpjUWDTknrrUg1V-ciFHbRZT1RZI1oLyZcKjB6iyejt6EybrfHn_Q4D3AhNDStE6NUc_6nijMFJLNdS-GqpUQy3VUE3RvLobeNeNtv-l-NmFApA9kMrXdGnjb4n-6foDy9DAPw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1771231842</pqid></control><display><type>article</type><title>SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Maiwall, R. ; Chandel, S. S. ; Wani, Z. ; Kumar, S. ; Sarin, S. K.</creator><creatorcontrib>Maiwall, R. ; Chandel, S. S. ; Wani, Z. ; Kumar, S. ; Sarin, S. K.</creatorcontrib><description>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.</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-015-3921-4</identifier><identifier>PMID: 26470868</identifier><identifier>CODEN: DDSCDJ</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Acute Kidney Injury - epidemiology ; Acute Kidney Injury - mortality ; Adult ; Analysis ; Bacterial infections ; Bacterial Infections - epidemiology ; Biochemistry ; Cohort Studies ; Disease Progression ; End Stage Liver Disease ; Female ; Gastroenterology ; Hepatic Encephalopathy - epidemiology ; Hepatitis ; Hepatitis, Alcoholic - epidemiology ; Hepatitis, Alcoholic - mortality ; Hepatology ; Hospital patients ; Hospitalization ; Humans ; Liver cirrhosis ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Oncology ; Original Article ; Patient outcomes ; Peritonitis - epidemiology ; Pneumonia, Bacterial - epidemiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Systemic Inflammatory Response Syndrome - epidemiology ; Systemic Inflammatory Response Syndrome - mortality ; Transplant Surgery ; Urinary Tract Infections - epidemiology</subject><ispartof>Digestive diseases and sciences, 2016-03, Vol.61 (3), p.920-929</ispartof><rights>Springer Science+Business Media New York 2015</rights><rights>COPYRIGHT 2016 Springer</rights><rights>Springer Science+Business Media New York 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c542t-2d668f26084ee90a081c92bb49c9c572bc6f2db6632ff056b99873431f1552d63</citedby><cites>FETCH-LOGICAL-c542t-2d668f26084ee90a081c92bb49c9c572bc6f2db6632ff056b99873431f1552d63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-015-3921-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-015-3921-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26470868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maiwall, R.</creatorcontrib><creatorcontrib>Chandel, S. S.</creatorcontrib><creatorcontrib>Wani, Z.</creatorcontrib><creatorcontrib>Kumar, S.</creatorcontrib><creatorcontrib>Sarin, S. K.</creatorcontrib><title>SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>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.</description><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - mortality</subject><subject>Adult</subject><subject>Analysis</subject><subject>Bacterial infections</subject><subject>Bacterial Infections - epidemiology</subject><subject>Biochemistry</subject><subject>Cohort Studies</subject><subject>Disease Progression</subject><subject>End Stage Liver Disease</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatic Encephalopathy - epidemiology</subject><subject>Hepatitis</subject><subject>Hepatitis, Alcoholic - epidemiology</subject><subject>Hepatitis, Alcoholic - mortality</subject><subject>Hepatology</subject><subject>Hospital patients</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Liver cirrhosis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patient outcomes</subject><subject>Peritonitis - epidemiology</subject><subject>Pneumonia, Bacterial - epidemiology</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Systemic Inflammatory Response Syndrome - epidemiology</subject><subject>Systemic Inflammatory Response Syndrome - mortality</subject><subject>Transplant Surgery</subject><subject>Urinary Tract Infections - epidemiology</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkstu1DAYhS0EokPhAdggS2zYpLWd-LaMWmBGFLViYG05jt26SuJge0Dt0-NoCgVUJOSFb985-o90AHiJ0RFGiB8njBhBFcK0qiXBVfMIrDDldUUoE4_BCmFWzhizA_AspWuEkOSYPQUHhDUcCSZW4Ha7-bSFOsO2H31KPkxwk6CGF9H23uQQYXCw_bCBp_abHcI82ilDPfXwY4hZDz7fQD_BdUizX663tocXOvtCJfjd5yu4LbpoYTuYcBUGb-DazgXIPj0HT5wekn1xtx-CL-_efj5ZV2fn7zcn7VllaENyRXrGhCMMicZaiTQS2EjSdY000lBOOsMc6TvGauIcoqyTUvC6qbHDlBZxfQje7H3nGL7ubMqqJDV2GPRkwy4pzDljjawx-g-UccQEogv6-i_0OuziVIIshpjUWDTknrrUg1V-ciFHbRZT1RZI1oLyZcKjB6iyejt6EybrfHn_Q4D3AhNDStE6NUc_6nijMFJLNdS-GqpUQy3VUE3RvLobeNeNtv-l-NmFApA9kMrXdGnjb4n-6foDy9DAPw</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Maiwall, R.</creator><creator>Chandel, S. S.</creator><creator>Wani, Z.</creator><creator>Kumar, S.</creator><creator>Sarin, S. K.</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7U9</scope><scope>H94</scope></search><sort><creationdate>20160301</creationdate><title>SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis</title><author>Maiwall, R. ; Chandel, S. S. ; Wani, Z. ; Kumar, S. ; Sarin, S. K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c542t-2d668f26084ee90a081c92bb49c9c572bc6f2db6632ff056b99873431f1552d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - mortality</topic><topic>Adult</topic><topic>Analysis</topic><topic>Bacterial infections</topic><topic>Bacterial Infections - epidemiology</topic><topic>Biochemistry</topic><topic>Cohort Studies</topic><topic>Disease Progression</topic><topic>End Stage Liver Disease</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatic Encephalopathy - epidemiology</topic><topic>Hepatitis</topic><topic>Hepatitis, Alcoholic - epidemiology</topic><topic>Hepatitis, Alcoholic - mortality</topic><topic>Hepatology</topic><topic>Hospital patients</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Liver cirrhosis</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Patient outcomes</topic><topic>Peritonitis - epidemiology</topic><topic>Pneumonia, Bacterial - epidemiology</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Systemic Inflammatory Response Syndrome - epidemiology</topic><topic>Systemic Inflammatory Response Syndrome - mortality</topic><topic>Transplant Surgery</topic><topic>Urinary Tract Infections - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maiwall, R.</creatorcontrib><creatorcontrib>Chandel, S. S.</creatorcontrib><creatorcontrib>Wani, Z.</creatorcontrib><creatorcontrib>Kumar, S.</creatorcontrib><creatorcontrib>Sarin, S. K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maiwall, R.</au><au>Chandel, S. S.</au><au>Wani, Z.</au><au>Kumar, S.</au><au>Sarin, S. K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>61</volume><issue>3</issue><spage>920</spage><epage>929</epage><pages>920-929</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><coden>DDSCDJ</coden><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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26470868</pmid><doi>10.1007/s10620-015-3921-4</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2016-03, Vol.61 (3), p.920-929 |
| issn | 0163-2116 1573-2568 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1776649310 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Acute Kidney Injury - epidemiology Acute Kidney Injury - mortality Adult Analysis Bacterial infections Bacterial Infections - epidemiology Biochemistry Cohort Studies Disease Progression End Stage Liver Disease Female Gastroenterology Hepatic Encephalopathy - epidemiology Hepatitis Hepatitis, Alcoholic - epidemiology Hepatitis, Alcoholic - mortality Hepatology Hospital patients Hospitalization Humans Liver cirrhosis Male Medicine Medicine & Public Health Middle Aged Mortality Oncology Original Article Patient outcomes Peritonitis - epidemiology Pneumonia, Bacterial - epidemiology Prognosis Retrospective Studies Risk Factors Severity of Illness Index Systemic Inflammatory Response Syndrome - epidemiology Systemic Inflammatory Response Syndrome - mortality Transplant Surgery Urinary Tract Infections - epidemiology |
| title | SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis |
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