Procalcitonin as a marker of sepsis in alcoholic hepatitis

Kumar, K. Kishore; Mohindra, Samir; Raj, Mithun; Choudhuri, Gourdas

doi:10.1007/s12072-014-9540-x

Cited by 24 publications

(25 citation statements)

References 30 publications

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“…This biomarker can be clinically useful because it can help in detecting patients who would benefit from early therapy with broad‐spectrum antibiotics. This finding is consistent with a recent study showing that procalcitonin can be useful as a biomarker of infections in patients with AH and SIRS …”

Section: Discussionsupporting

confidence: 93%

“…This finding is consistent with a recent study showing that procalcitonin can be useful as a biomarker of infections in patients with AH and SIRS. 31 Another relevant result from our study is that LPS serum levels at admission predict which patients will not respond to corticosteroids. There is mounting evidence that patients with alcoholic liver disease have profound dysbacteriosis and impaired tight junctions in the intestinal mucosa, favoring the translocation of gram-negative bacterial products such as LPS to the portal vein.…”

Section: Discussionmentioning

confidence: 78%

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Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis

et al. 2015

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Alcoholic hepatitis (AH) frequently progresses to multiple organ failure (MOF) and death. However, the driving factors are largely unknown. At admission, patients with AH often show criteria of systemic inflammatory response syndrome (SIRS) even in the absence of an infection. We hypothesize that the presence of SIRS may predispose to MOF and death. To test this hypothesis, we studied a cohort including 162 patients with biopsy-proven AH. The presence of SIRS and infections was assessed in all patients, and multivariate analyses identified variables independently associated with MOF and 90-day mortality. At admission, 32 (19.8%) patients were diagnosed with a bacterial infection, while 75 (46.3%) fulfilled SIRS criteria; 58 patients (35.8%) developed MOF during hospitalization. Short-term mortality was significantly higher among patients who developed MOF (62.1% versus 3.8%, P <0.001). The presence of SIRS was a major predictor of MOF (odds ratio = 2.69, P=0.025) and strongly correlated with mortality. Importantly, the course of patients with SIRS with and without infection was similar in terms of MOF development and short-term mortality. Finally, we sought to identify serum markers that differentiate SIRS with and without infection. We studied serum levels of high-sensitivity C-reactive protein, procalcitonin, and lipopolysaccharide at admission. All of them predicted mortality. Procalcitonin, but not high-sensitivity C-reactive protein, serum levels identified those patients with SIRS and infection. Lipopolysaccharide serum levels predicted MOF and the response to prednisolone. Conclusion In the presence or absence of infections, SIRS is a major determinant of MOF and mortality in AH, and the mechanisms involved in the development of SIRS should be investigated; procalcitonin serum levels can help to identify patients with infection, and lipopolysaccharide levels may help to predict mortality and the response to steroids.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 78%

Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis

et al. 2015

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“…(Altamirano et al, 2012, Maiwall et al, 2015, Rincon et al, 2007, Singal et al, 2012b, Hmoud et al, 2015, Altamirano et al, 2011, Gustot et al, 2014, Michelena et al, 2015) Serum markers like pro-calcitonin, lipopolysaccharide, liver progenitor cell proliferation, soluble TNF-receptor1, and mitochondrial bioenergetics are emerging non-invasive biomarkers to identify severe AH patients at risk for developing worsening liver failure and bad outcome. (Sancho-Bru et al, 2012, Kumar et al, 2014, Duvoux et al, 2004, Spahr et al, 2004, Singal et al, 2014a, Michelena et al, 2015) There is currently an ongoing observational study examining the role of interleukin 22 serum levels predicting disease severity and outcome of AH patients (https://clinicaltrials.gov/ct2/show/NCT01918462?term=il-22&rank=2). Data are also emerging on the role of liver biopsy in predicting outcome and response to therapy.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and Treatment of Alcoholic Hepatitis: A Systematic Review

Singal

Kodali

Vucovich

et al. 2016

Alcohol Clin Exp Res

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Alcoholic hepatitis occurs in about one third of individuals reporting long term heavy alcohol use. It is associated with high short-term mortality, economic burden, and hospital resources utilization. We performed this systematic review to a) describe clinical characteristics and genomics associated with the risk of alcoholic hepatitis; b) discuss role and limitations of liver biopsy and prognostic scoring systems; c) summarize evidence regarding the currently available therapies including liver transplantation; and d) outline emerging therapies with areas of unmet need. Literature search was performed for studies published in English language (January 1971 through - March 2016). Following search engines were used: Pubmed, Elsevier Embase, PsychINFO, and Cochrane Library. For the treatment section, only randomized controlled studies were included for this review. A total of 138 studies (59 randomized, 22 systematic reviews or meta-analyses, 7 surveys or guidelines, 7 population based, and 43 prospective cohort) were cited. There are over 325,000 annual admissions with alcoholic hepatitis contributing to about 0.8% of all hospitalizations in the US. Liver biopsy may be required in about 25–30% cases for uncertain clinical diagnosis. Corticosteroids with or without N-acetylcysteine remains the only available therapy for severe episode. Data are emerging on the role of liver transplantation as salvage therapy for select patients. Abstinence remains the most important factor impacting long-term prognosis. Results from the ongoing clinical trials within the National institute on Alcohol Abuse and Alcoholism funded consortia are awaited for more effective and safer therapies. Alcoholic hepatitis is a potentially lethal condition with a significant short-term mortality. A high index of suspicion is required. There remains an unmet need for non-invasive biomarkers for diagnosis, and predicting prognosis and response to therapy.

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“…Even when data regarding the actual antibiotic therapy used was not available, it must be assumed that the lack of PCT reduction indicates inadequate antibiotic therapy. Other studies, in which the relationship between inadequate antibiotic therapy in sepsis and survival was analyzed, reported death rates in inadequately treated groups became as high as 90% [24,25].…”

Section: Discussionmentioning

confidence: 98%

Procalcitonin: a valuable markerfor assessment of the success of antimicrobial therapy for severe sepsis An analysis using routine clinical data

Wilke

2016

MRAJ

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Procalcitonin as a marker of sepsis in alcoholic hepatitis

Abstract: Serum PCT can be a useful marker for diagnosing sepsis in patients with alcoholic hepatitis and SIRS and compares favorably with serum CRP levels.

Cited by 24 publications

References 30 publications

Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis

Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis

Diagnosis and Treatment of Alcoholic Hepatitis: A Systematic Review

Procalcitonin: a valuable markerfor assessment of the success of antimicrobial therapy for severe sepsis An analysis using routine clinical data

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