SAN DIEGO — Data link systemic inflammatory response syndrome and sepsis with a nearly threefold increase in mortality among patients with alcoholic hepatitis, according to a retrospective meta-analysis presented at Digestive Disease Week 2016.
Veeravich Jaruvongvanich, MD, of the Department of Medicine and the Department of Internal Medicine at Chulalongkorn University in Thailand, and colleagues, noted that systemic inflammatory response syndrome and sepsis are frequently observed in patients with severe alcoholic hepatitis who experience multi-organ failure and untimely death. They conducted a systematic review and meta-analysis to determine how these two conditions are associated with mortality in this patient population. They compared mortality outcomes with controls who did not have these conditions.
The researchers searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases from their dates of inception through October 2015. Eligible patients were those with alcoholic hepatitis who developed one of the two conditions during hospitalization and had no other causes of liver disease at baseline. Risk ratios for mortality among participants with systemic inflammatory response syndrome or sepsis were calculated compared with those for patients without those conditions.
The initial search yielded 1,000 articles. Jaruvongvanich reported on data for nine studies, which were all retrospective cohorts.
Six studies included patients with systemic inflammatory response syndrome. The data sets ranged from 51 to 515 patients. The total was 1,264 patients, of whom 567 had the syndrome.
Assessment of the syndrome occurred within 48 hours of hospital admission. Mortality assessment timing ranged from in-hospital to 90 days.
The pooled risk ratio for mortality among patients with systemic inflammatory response syndrome compared to those without was 2.68 (95% CI, 1.74-4.14).
There were four studies that included patients with sepsis. These ranged from around 100 patients to nearly 57,000 patients. Sepsis diagnosis occurred at admission in two of the studies.
The risk ratio for mortality in the sepsis compared with the non-sepsis group was 2.80 (95% CI, 1.58-4.93).
“[Systemic inflammatory response syndrome] and sepsis appear to be major determinants of mortality in alcoholic hepatitis,” Jaruvongvanich concluded. “Hepatocyte death may lead to damage-associated molecular patterns, which activates inflammatory cytokines and leads to sterile inflammatory response.”
Jaruvongvanich V, et al. Abstract #351. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.
Disclosures: Jaruvongvanich reports no relevant financial disclosures.