title: SIRS at Admission Is a Predictor of AKI Development and Mortality in Hospitalized Patients with Severe Alcoholic Hepatitis.
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).
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
authors.forename: R
authors.initials: R
authors.lastname: Maiwall
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Chandel
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
authors.forename: Z
authors.initials: Z
authors.lastname: Wani
authors.affiliation: Department of Clinical Hematology, Command Hospital [Eastern Command], Kolkata, India.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India. shivsarin@gmail.com.
authors.forename: S K
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology*; D015331:Cohort Studies; D018450:Disease Progression; D058625:End Stage Liver Disease; D005260:Female; D006501:Hepatic Encephalopathy / Q000453:epidemiology; D006519:Hepatitis, Alcoholic / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010538:Peritonitis / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology* / Q000401:mortality; D014552:Urinary Tract Infections / Q000453:epidemiology
keywords: AKI; AKI progression; SIRS; Severe alcoholic hepatitis