Prognostic Utility of Systemic Inflammatory Response Syndrome (SIRS) Criteria in Acute Alcohol-Associated Hepatitis

Acute alcohol-associated hepatitis (AAH) is a severe inflammatory liver condition with high morbidity and mortality. Many patients with AAH exhibit features of the Systemic Inflammatory Response Syndrome (SIRS). While Maddrey's Discriminant Function (MDF) and Model for End-Stage Liver Disease (MELD) are established tools used to assess severity and guide treatment, the prognostic utility of SIRS criteria remains unclear. We hypothesized that AAH patients with more SIRS criteria would show greater illness severity, reduced steroid responsiveness, and worse 30-day survival.

Retrospective analysis was conducted on 531 AAH patients hospitalized between 2012 and 2019. Patients were stratified into ≥ 2 SIRS criteria (n = 243) and < 2 criteria (n = 288). Demographics, laboratory parameters, and scoring system measures (MDF, MELD) were collected. The primary outcome was 30-day (30-d) survival. Secondary outcomes were disease severity (MELD) and response to steroids.

The mean age was 47; the majority were male (56%) and White (66%). Several baseline characteristics differed between groups. Patients with ≥ 2 SIRS criteria had significantly lower albumin (2.86 vs 2.97 g/dL, p = 0.035), higher MDF (40.1 vs 36.1, p = 0.004), higher admission MELD scores (20.9 vs 20.1, p = 0.04), and similar response to steroids (68% vs 64%). Thirty-day survival was numerically lower in the ≥ 2 SIRS group (86.9%) vs the < 2 group (91.5%) (p = 0.18), suggesting a trend toward worse outcomes with higher SIRS burden.

Higher SIRS criteria are associated with greater disease severity, similar biochemical and prognostic scoring abnormalities, as well as a non-significant trend toward worse 30-day survival. Further prospective studies are warranted to clarify prognostic value of SIRS, guide treatment and risk stratification in AAH.