Effect of SIRS and sepsis on mortality in alcoholic hepatitis: A systematic review and meta-analysis

Jaruvongvanich, Veeravich; Sanguankeo, Anawin; Upala, Sikarin

doi:10.5152/tjg.2016.16188

Cited by 4 publications

(2 citation statements)

References 24 publications

(28 reference statements)

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“…A careful search should be made for a source of potential infection or sepsis, including skin examination for signs of cellulitis and infection around venous lines. The systemic inflammatory response syndrome (SIRS 1") (presence of 2 or more of temperature .38 or ,36 degree Celsius, heart rate .90 bpm, respiratory rate .20 or PCO2 ,32 mm Hg, and white cell count .12 3 10 9 /L) may be present even in the absence of infection (152) and is associated with a nearly 3-fold risk of mortality (153). In addition, the presence of SIRS predicted the development of renal failure and 90-day mortality in 2 cohort studies (152,154).…”

Section: Ahmentioning

confidence: 99%

ACG Clinical Guideline: Alcohol-Associated Liver Disease

Jophlin,

Singal,

Bataller

et al. 2023

Am J Gastroenterol

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Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful alcohol use as the primary risk factor, increasing alcohol use over the past decade has resulted in rapid growth of the ALD-related healthcare burden. The spectrum of ALD ranges from early asymptomatic liver injury to advanced disease with decompensation and portal hypertension. Compared with those with other etiologies of liver disease, patients with ALD progress faster and more often present at an advanced stage. A unique phenotype of advanced disease is alcohol-associated hepatitis (AH) presenting with rapid onset or worsening of jaundice, and acute on chronic liver failure in severe forms conveying a 1-month mortality risk of 20%–50%. The model for end stage disease score is the most accurate score to stratify AH severity (>20 defined as severe disease). Corticosteroids are currently the only available therapeutic with proven efficacy for patients with severe AH, providing survival benefit at 1 month in 50%–60% of patients. Abstinence of alcohol use, a crucial determinant of long-term outcomes, is challenging to achieve in ALD patients with concurrent alcohol use disorder (AUD). As patients with ALD are rarely treated for AUD, strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD. Liver transplantation, a definitive treatment option in patients with advanced cirrhosis, should be considered in selected patients with AH, who are unresponsive to medical therapy and have a low risk of relapse to posttransplant alcohol use. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the American College of Gastroenterology Practice Parameters Committee.

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Section: Ahmentioning

confidence: 99%

ACG Clinical Guideline: Alcohol-Associated Liver Disease

Jophlin,

Singal,

Bataller

et al. 2023

Am J Gastroenterol

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“…Patients with alcohol-associated hepatitis are particularly susceptible to acute kidney injury and/or sepsis, with progression to multiorgan failure and death. [24][25][26] There is a clinical need for biomarkers for early detection and distinction from pre-existing kidney disease especially as creatinine measurements can be misleading due to underlying sarcopenia. [27] Sepsis is the leading cause of death in alcoholassociated hepatitis.…”

Section: Alcohol-associated Liver Disordersmentioning

confidence: 99%

The future of hepatology

Friedman

Sanyal

2023

Hepatology

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The field of hepatology has made impressive progress over its ~75 years of existence. Advances in understanding liver function and its dysregulation in disease, genetic determinants of disease, antiviral therapy, and transplantation have transformed the lives of patients. However, there are still significant challenges that require ongoing creativity and discipline, particularly with the emergence of fatty liver diseases, as well as managing autoimmune disease, cancer, and liver disease in children. Diagnostic advances are urgently needed to accelerate risk stratification and efficient testing of new agents with greater precision in enriched populations.Integrated, holistic care models should be extended beyond liver cancer to diseases like NAFLD with systemic manifestations or extrahepatic comorbidities such as cardiovascular disease, diabetes, addiction, and depressive disorders. To meet the growing burden of asymptomatic liver disease, the workforce will need to be expanded by incorporating more advanced practice providers and educating other specialists. The training of future hepatologists will benefit from incorporating emerging skills in data management, artificial intelligence, and precision medicine. Continued investment in basic and translational science is crucial for further progress. The challenges ahead are significant, but with collective effort, the field of hepatology will continue to make progress and overcome obstacles.

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Influence of Systemic Inflammatory Response Syndrome on the Development of Oxidative Stress During Simulation of Chronic Alcohol Intoxication in Rats

Mykytenko¹

2022

Biotechnol. acta

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The aim of our study was to analyze changes in the development of oxidative stress in the liver of rats with chronic alcohol intoxication against the background of systemic inflammatory response syndrome based on the study of catalase and superoxide dismutase activity, concentration of malonic dialdehyde, oxidatively modified proteins and sulfide anion and superoxide anion production. Methods. Experimental studies were performed on 12 male Wistar rats weighing 180‒220 g. Animals were divided into two groups: 1 ‒ control and 2 ‒ animals, on which we simulated alcoholic hepatitis and SIRS. The activity of catalase and superoxide dismutase (SOD), the concentration of malonic dialdehyde (MDA) , oxidatively modified proteins (OMP) sulfide anion and superoxide anion production were studied in the rat liver homogenate. The obtained results were subjected to statistical processing using the Mann-Whitney test. Results. Analyzing the development of oxidative stress in the liver of rats, on which we simulated the combined effects of SIRS and prolonged alcohol intoxication, we found that the activity of SOD increased by 1.72 times (P<0.05), and catalase decreased by 1.18 times (P<0.05) compared with the control group. The production of superoxide anion radical in the liver of rats increased 2.21 times (P<0.05) in the group of animals with combined exposure to bacterial LPS and alcohol intoxication compared to control. The concentration of MDA increased 2.25 times (P<0.05), and OMP by 9.5 times (P<0.05) compared with control group. The concentration of sulfide anion in the liver of rats under the conditions of modeling the combined effects of SIRS and alcohol intoxication decreased by 1.44 times (P <0.05) compared with the control. Conclusions. Modeling of alcohol intoxication against the background of systemic inflammatory response syndrome leads to oxidative damage to lipid and protein structures of the liver due to increased production of superoxide anion radical and imbalance of antiradical protection.

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Effect of SIRS and sepsis on mortality in alcoholic hepatitis: A systematic review and meta-analysis

Cited by 4 publications

References 24 publications

ACG Clinical Guideline: Alcohol-Associated Liver Disease

ACG Clinical Guideline: Alcohol-Associated Liver Disease

The future of hepatology

Influence of Systemic Inflammatory Response Syndrome on the Development of Oxidative Stress During Simulation of Chronic Alcohol Intoxication in Rats

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