Maiwall R, Chandel S S, Wani Z, Kumar S, Sarin S K
Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
Department of Clinical Hematology, Command Hospital [Eastern Command], Kolkata, India.
Dig Dis Sci. 2016 Mar;61(3):920-9. doi: 10.1007/s10620-015-3921-4. Epub 2015 Oct 15.
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.
全身炎症反应综合征（SIRS）与肝硬化患者发生肝性脑病、肾衰竭及不良预后的风险增加相关；然而，针对严重酒精性肝炎（SAH）患者的这一情况的研究较少。
评估基线时的SIRS作为SAH患者发生急性肾损伤（AKI）及死亡的预测指标。
对基线时无AKI的连续性SAH住院患者（判别函数≥32）进行随访，观察AKI的发生及进展情况（采用AKIN标准）。
在365例患者（平均年龄45.5±9.5岁，男性356例）中，236例（64.6%）在基线时存在SIRS。122例（33.4%）发生了AKI，其中50例（40.9%）出现AKI进展。SIRS与96例（40.6%）细菌感染相关，140例（59.3%）在无微生物学证实感染的情况下发生。SIRS的存在可预测AKI的发生（p<0.001，OR 2.9, 95%CI 1.7 - 4.8）及AKI进展（p = 0.002，OR 3.27, 95%CI 1.48 - 7.21）。AKI的缓解也与SIRS呈显著负相关（p = 0.001）。高MELD评分（p = 0.002，HR 1.1, 95%CI 1.02 - 1.09）、住院期间AKI进展（p = 0.04，HR 1.54, 95%CI 1.003 - 2.38）及SIRS（p = 0.004，HR 1.98, 95%CI 1.25 - 3.1）是90天死亡率的显著预测指标（模型1），而高MELD评分（p<0.001，HR 1.1, 95%CI 1.04 - 1.12）及细菌感染（p = 0.001，HR 1.8, 95%CI 1.27 - 2.6）是第二个多变量模型（模型2）中死亡率的独立预测指标。
入院时的SIRS可预测SAH患者AKI的发生及90天死亡率。这肯定具有治疗及预后意义。
