title: Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids.
abstract: OBJECTIVE
  To determine whether infection in patients with acute severe alcoholic hepatitis (AAH) treated with corticosteroids is associated with increased mortality.
  
  
  METHODS
  Consecutive patients with AAH were treated with steroids and recruited to the study. Clinically relevant infections (body temperature > 38 °C or < 36 °C for more than 4 h, ascitic neutrophil count > 0.25 ×109/L, consolidation on chest radiograph or clinically relevant positive microbiological culture of bodily fluid) were recorded prospectively. Clinical and laboratory parameters were recorded and survival at 90 d and 6 mo was determined. Univariate analysis of factors associated with 90-d mortality was performed and significant variables included in a multivariate analysis.
  
  
  RESULTS
  Seventy-two patients were included in the final analysis (mean age 47.9 years, 26% female, mean discriminant function 53.0). Overall mortality in the group occurred in 15 (21%), 23 (32%) and 31 (43%) at day 28, day 90 and 1 year respectively. 36 (50%) had a clinically relevant infection during their hospitalisation (23 after initiation of steroids). The median time to development of incident infection after commencement of steroids was 10 d. The commonest site of infection was ascites (31%) and bacteraemia (31%) followed by urinary tract (19%) and respiratory tract (8%). Forty-one separate organisms were isolated in 33 patients; the most frequent genus was Escherichia (22%) and Enterococcus (20%). Infection was not associated with 90-d or 1 year mortality but was associated with higher creatinine, model for end-stage liver disease and Lille score. Baseline urea was the only independent predictor of 90-d mortality.
  
  
  CONCLUSIONS
  Clinically relevant infections are common in patients with AAH but are not associated with increased 90-d or 1 year mortality.
authors.affiliation: Ashwin D Dhanda, Matthew E Cramp, Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth PL6 8BU, United Kingdom.
authors.forename: Ashwin D
authors.initials: AD
authors.lastname: Dhanda
authors.affiliation: Ashwin D Dhanda, Matthew E Cramp, Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth PL6 8BU, United Kingdom.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Ashwin D Dhanda, Matthew E Cramp, Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth PL6 8BU, United Kingdom.
authors.forename: Vicky
authors.initials: V
authors.lastname: Hunt
authors.affiliation: Ashwin D Dhanda, Matthew E Cramp, Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth PL6 8BU, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.affiliation: Ashwin D Dhanda, Matthew E Cramp, Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth PL6 8BU, United Kingdom.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Cramp
authors.affiliation: Ashwin D Dhanda, Matthew E Cramp, Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth PL6 8BU, United Kingdom.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Collins
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000097:blood / Q000150:complications* / Q000382:microbiology; D003404:Creatinine / Q000097:blood; D058625:End Stage Liver Disease / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014508:Urea / Q000097:blood
chemical_list: D005938:Glucocorticoids; D014508:Urea; D003404:Creatinine
keywords: Alcoholic hepatitis; Corticosteroids; Escherichia; Infection; Lille score