{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:33:32Z","timestamp":1792035212445,"version":"4.4.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":141,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:p>\n                    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\u2010proven AH. The presence of SIRS and infections was assessed in all patients, and multivariate analyses identified variables independently associated with MOF and 90\u2010day 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\u2010term mortality was significantly higher among patients who developed MOF (62.1% versus 3.8%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u20090.001). The presence of SIRS was a major predictor of MOF (odds ratio\u2009=\u20092.69,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u20090.025) 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\u2010term mortality. Finally, we sought to identify serum markers that differentiate SIRS with and without infection. We studied serum levels of high\u2010sensitivity C\u2010reactive protein, procalcitonin, and lipopolysaccharide at admission. All of them predicted mortality. Procalcitonin, but not high\u2010sensitivity C\u2010reactive protein, serum levels identified those patients with SIRS and infection. Lipopolysaccharide serum levels predicted MOF and the response to prednisolone.\n                    <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>\n                    : 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. (H\n                    <jats:sc>epatology<\/jats:sc>\n                    2015;62:762\u2013772)\n                  <\/jats:p>","DOI":"10.1002\/hep.27779","type":"journal-article","created":{"date-parts":[[2015,3,11]],"date-time":"2015-03-11T19:35:21Z","timestamp":1426102521000},"page":"762-772","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":266,"title":["Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis"],"prefix":"10.1097","volume":"62","author":[{"given":"Javier","family":"Michelena","sequence":"first","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Altamirano","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"},{"name":"Liver Unit,Department of Internal Medicine,Vall d'Hebron Institut de Recerca,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan G.","family":"Abraldes","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology,Department of Medicine,University of Alberta,Edmonton,Alberta,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Aff\u00f2","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriol","family":"Morales\u2010Ibanez","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pau","family":"Sancho\u2010Bru","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Dominguez","sequence":"additional","affiliation":[{"name":"Servicio de Gastroenterolog\u00eda,Hospital Domingo Luciani,Caracas,Venezuela"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Garc\u00eda\u2010Pag\u00e1n","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"},{"name":"Hepatic Hemodynamic Laboratory,Hospital Clinic,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Arroyo","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pere","family":"Gin\u00e8s","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Louvet","sequence":"additional","affiliation":[{"name":"INSERM U995,Universit\u00e9 Lille Nord de France,Lille,France"},{"name":"Service de Maladies de l'Apareil Digestif et de la Nutrition,H\u00f4pital Claude Huriez,Lille,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Mathurin","sequence":"additional","affiliation":[{"name":"INSERM U995,Universit\u00e9 Lille Nord de France,Lille,France"},{"name":"Service de Maladies de l'Apareil Digestif et de la Nutrition,H\u00f4pital Claude Huriez,Lille,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wajahat Z.","family":"Mehal","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases,Yale University,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Caballer\u00eda","sequence":"additional","affiliation":[{"name":"Liver Unit,Hospital Cl\u00ednic,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram\u00f3n","family":"Bataller","sequence":"additional","affiliation":[{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer, University of Barcelona, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas,Barcelona,Spain"},{"name":"Division of Gastroenterology and Hepatology,Departments of Medicine and Nutrition,University of North Carolina at Chapel Hill,Chapel Hill,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2015,4,13]]},"reference":[{"key":"hep27779-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1056\/NEJMra0805786","article-title":"Alcoholic hepatitis","volume":"360","year":"2009","journal-title":"N Engl J Med"},{"key":"hep27779-bib-0002-20241017","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1136\/gut.2010.224097","article-title":"Corticosteroids improve short\u2010term survival in patients with severe alcoholic hepatitis: meta\u2010analysis of individual patient data","volume":"60","year":"2011","journal-title":"Gut"},{"key":"hep27779-bib-0003-20241017","doi-asserted-by":"crossref","first-page":"2747","DOI":"10.1111\/j.1572-0241.2008.02104.x","article-title":"A new scoring system for prognostic stratification of patients with alcoholic hepatitis","volume":"103","year":"2008","journal-title":"Am J Gastroenterol"},{"key":"hep27779-bib-0004-20241017","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute\u2010on\u2010chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","year":"2013","journal-title":"Gastroenterology"},{"key":"hep27779-bib-0005-20241017","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.cgh.2011.09.011","article-title":"Acute kidney injury is an early predictor of mortality for patients with alcoholic hepatitis","volume":"10","year":"2012","journal-title":"Clin Gastroenterol Hepatol"},{"key":"hep27779-bib-0006-20241017","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1053\/j.gastro.2009.04.062","article-title":"Infection in patients with severe alcoholic hepatitis treated with steroids: early response to therapy is the key factor","volume":"137","year":"2009","journal-title":"Gastroenterology"},{"key":"hep27779-bib-0007-20241017","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1053\/j.gastro.2012.09.008","article-title":"Sterile inflammation in the liver","volume":"143","year":"2012","journal-title":"Gastroenterology"},{"key":"hep27779-bib-0008-20241017","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1053\/j.gastro.2009.01.056","article-title":"Hepatic expression of CXC chemokines predicts portal hypertension and survival in patients with alcoholic hepatitis","volume":"136","year":"2009","journal-title":"Gastroenterology"},{"key":"hep27779-bib-0009-20241017","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1136\/gutjnl-2013-306098","article-title":"CCL20 mediates lipopolysaccharide induced liver injury and is a potential driver of inflammation and fibrosis in alcoholic hepatitis","volume":"63","year":"2014","journal-title":"Gut"},{"key":"hep27779-bib-0010-20241017","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jhep.2013.09.011","article-title":"Invasive aspergillosis in patients with severe alcoholic hepatitis","volume":"60","year":"2014","journal-title":"J Hepatol"},{"key":"hep27779-bib-0011-20241017","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1016\/j.jhep.2011.12.030","article-title":"C\u2010reactive protein predicts short\u2010term mortality in patients with cirrhosis","volume":"56","year":"2012","journal-title":"J Hepatol"},{"key":"hep27779-bib-0012-20241017","first-page":"599","article-title":"Acute phase proteins for the diagnosis of bacterial infections and prediction of mortality in acute complications of cirrhosis","volume":"12","year":"2013","journal-title":"Ann Hepatol"},{"key":"hep27779-bib-0013-20241017","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1002\/hep.23009","article-title":"Endotoxemia and gut barrier dysfunction in alcoholic liver disease","volume":"50","year":"2009","journal-title":"Hepatology"},{"key":"hep27779-bib-0014-20241017","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1097\/00003246-199206000-00025","article-title":"Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP\/SCCM Consensus Conference Committee","volume":"20","year":"1992","journal-title":"Crit Care Med"},{"key":"hep27779-bib-0015-20241017","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"on behalf of the Working Group on Sepsis\u2010related Problems of the European Society of Intensive Care Medicine. The SOFA (Sepsis\u2010related Organ Failure Assessment) score to describe organ dysfunction\/failure","volume":"22","year":"1996","journal-title":"Intensive Care Med"},{"key":"hep27779-bib-0016-20241017","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1097\/00003246-199811000-00016","article-title":"Use of the SOFA score to assess the incidence of organ dysfunction\/failure in intensive care units: results of a multicenter prospective study","volume":"26","year":"1998","journal-title":"Crit Care Med"},{"key":"hep27779-bib-0017-20241017","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0016-5085(78)90401-8","article-title":"Corticosteroid therapy of alcoholic hepatitis","volume":"75","year":"1978","journal-title":"Gastroenterology"},{"key":"hep27779-bib-0018-20241017","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1002\/hep.21607","article-title":"The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids","volume":"45","year":"2007","journal-title":"Hepatology"},{"key":"hep27779-bib-0019-20241017","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1053\/j.gastro.2014.01.018","article-title":"A histologic scoring system for prognosis of patients with alcoholic hepatitis","volume":"146","year":"2014","journal-title":"Gastroenterology"},{"key":"hep27779-bib-0020-20241017","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1056\/NEJMoa1105703","article-title":"Early liver transplantation for severe alcoholic hepatitis","volume":"365","year":"2011","journal-title":"N Engl J Med"},{"key":"hep27779-bib-0021-20241017","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1016\/S0168-8278(14)60141-0","article-title":"Alcoholic hepatitis resistant to medical therapy is characterized by an altered differentiation of hepatic progenitors under the influence of extracellular matrix [Abstract]","volume":"60","year":"2014","journal-title":"J Hepatol"},{"key":"hep27779-bib-0022-20241017","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1136\/gut.2009.189639","article-title":"Early features of acute\u2010on\u2010chronic alcoholic liver failure: a prospective cohort study","volume":"59","year":"2010","journal-title":"Gut"},{"key":"hep27779-bib-0023-20241017","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/j.jhep.2011.02.021","article-title":"The role of liver biopsy in the diagnosis and prognosis of patients with acute deterioration of alcoholic cirrhosis","volume":"55","year":"2011","journal-title":"J Hepatol"},{"key":"hep27779-bib-0024-20241017","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1002\/hep.26521","article-title":"Human and experimental evidence supporting a role for osteopontin in alcoholic hepatitis","volume":"58","year":"2013","journal-title":"Hepatology"},{"key":"hep27779-bib-0025-20241017","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.pan.2012.01.002","article-title":"Recombinant human activated protein C as a disease modifier in severe acute pancreatitis: systematic review of current evidence","volume":"12","year":"2012","journal-title":"Pancreatology"},{"key":"hep27779-bib-0026-20241017","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/jgh.12018","article-title":"Sterile inflammation in the liver and pancreas","volume":"28","year":"2013","journal-title":"J Gastroenterol Hepatol"},{"key":"hep27779-bib-0027-20241017","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1172\/JCI59755","article-title":"The mechanism underlying acetaminophen\u2010induced hepatotoxicity in humans and mice involves mitochondrial damage and nuclear DNA fragmentation","volume":"122","year":"2012","journal-title":"J Clin Invest"},{"key":"hep27779-bib-0028-20241017","doi-asserted-by":"crossref","first-page":"3476","DOI":"10.1172\/JCI60777","article-title":"IL\u20101 receptor antagonist ameliorates inflammasome\u2010dependent alcoholic steatohepatitis in mice","volume":"122","year":"2012","journal-title":"J Clin Invest"},{"key":"hep27779-bib-0029-20241017","doi-asserted-by":"crossref","first-page":"2328","DOI":"10.1002\/hep.25947","article-title":"Second infections independently increase mortality in hospitalized patients with cirrhosis: the North American consortium for the study of end\u2010stage liver disease (NACSELD) experience","volume":"56","year":"2012","journal-title":"Hepatology"},{"key":"hep27779-bib-0030-20241017","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1002\/hep.26687","article-title":"Type\u20101 hepatorenal syndrome associated with infections in cirrhosis: natural history, outcome of kidney function, and survival","volume":"59","year":"2014","journal-title":"Hepatology"},{"key":"hep27779-bib-0031-20241017","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1007\/s12072-014-9540-x","article-title":"Procalcitonin as a marker of sepsis in alcoholic hepatitis","volume":"8","year":"2014","journal-title":"Hepatol Int"},{"key":"hep27779-bib-0032-20241017","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1053\/j.gastro.2014.01.020","article-title":"Interactions between the intestinal microbiome and liver diseases","volume":"146","year":"2014","journal-title":"Gastroenterology"},{"key":"hep27779-bib-0033-20241017","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1053\/jhep.2003.50182","article-title":"Toll\u2010like receptor 4 mediates inflammatory signaling by bacterial lipopolysaccharide in human hepatic stellate cells","volume":"37","year":"2003","journal-title":"Hepatology"},{"key":"hep27779-bib-0034-20241017","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jhep.2014.03.014","article-title":"Inflammation and portal hypertension\u2014the undiscovered country","volume":"61","year":"2014","journal-title":"J Hepatol"},{"key":"hep27779-bib-0035-20241017","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/j.jhep.2013.12.019","article-title":"Altered profile of human gut microbiome is associated with cirrhosis and its complications","volume":"60","year":"2014","journal-title":"J Hepatol"},{"key":"hep27779-bib-0036-20241017","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1016\/j.jhep.2012.06.026","article-title":"Acute\u2010on chronic liver failure","volume":"57","year":"2012","journal-title":"J Hepatol"}],"container-title":["Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhep.27779","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01515467-201509000-00015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T20:49:10Z","timestamp":1729198150000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01515467-201509000-00015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,4,13]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2015]]}},"URL":"https:\/\/doi.org\/10.1002\/hep.27779","relation":{},"ISSN":["0270-9139","1527-3350"],"issn-type":[{"value":"0270-9139","type":"print"},{"value":"1527-3350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,4,13]]},"assertion":[{"value":"2014-10-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-03-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}