{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T20:57:31Z","timestamp":1765486651866,"version":"3.40.5"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","license":[{"start":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T00:00:00Z","timestamp":1627430400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>Alcohol\u2010associated hepatitis (AAH) is a severe form of liver injury with mortality as high as 30%\u201040% at 90\u00a0days. As a result of altered immune function in AAH, bacterial infections are common and are associated with poor outcomes. However, determining the risk and subsequent development of infection in patients with AAH remain challenging. We performed a retrospective study of consecutive patients admitted with a diagnosis of AAH at two independent tertiary centers from 1998 to 2018 (test cohort, n\u00a0=\u00a0286) who developed infections following hospitalization. The diagnosis of AAH was confirmed by manual chart review according to the recent National Institute on Alcohol Abuse and Alcoholism definition. Infections were categorized by location and time of diagnosis as hospital\u2010acquired infection (48\u00a0hours after admission until discharge) and posthospital infections (up to 6\u00a0months following discharge). The cohort was 66% men, and the median age was 48 (21\u201083) years. Corticosteroids were used in 32% of all patients with AAH. The overall infection rate was 24%. Of those with infections, 46% were hospital acquired and 54% were acquired after hospitalization. Variables found to be significant risk factors for bacterial infection included the presence of ascites on admission (hazard ratio [HR], 2.06), corticosteroid administration (HR, 1.70), Model for End\u2010Stage Liver Disease (MELD) &gt;23 (HR, 2.61), and white blood cell (WBC) count on admission per point (HR, 1.02). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> In this multicenter cohort study of patients hospitalized with AAH, MELD score, ascites, WBC count, and use of corticosteroids were identified as significant predictors of the development of bacterial infection. We created a novel predictive equation that may be used to aid in the identification of patients with AAH at high risk of infection.<\/jats:p>","DOI":"10.1002\/hep4.1786","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T10:11:40Z","timestamp":1627467100000},"page":"2096-2103","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol\u2010Associated Hepatitis"],"prefix":"10.1097","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9357-9511","authenticated-orcid":false,"given":"Daniel D.","family":"Penrice","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic Rochester,Rochester,MN,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic Rochester,Rochester,MN,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille A.","family":"Kezer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Mayo Clinic Rochester,Rochester,MN,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thoetchai Bee","family":"Peeraphatdit","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic Rochester,Rochester,MN,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arun J.","family":"Sanyal","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition,Virginia Commonwealth University,Richmond,VA,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7567-6748","authenticated-orcid":false,"given":"Brian","family":"Davis","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition,Virginia Commonwealth University,Richmond,VA,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin C.","family":"Mara","sequence":"additional","affiliation":[{"name":"Division of Biostatistics,Mayo Clinic Rochester,Rochester,MN,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7620-573X","authenticated-orcid":false,"given":"Vijay H.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic Rochester,Rochester,MN,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick S.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic Rochester,Rochester,MN,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas A.","family":"Simonetto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic Rochester,Rochester,MN,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"key":"hep41786-bib-0001-20241015","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1056\/NEJMoa1412278","article-title":"Prednisolone or pentoxifylline for alcoholic hepatitis","volume":"372","year":"2015","journal-title":"N Engl J Med"},{"key":"hep41786-bib-0002-20241015","doi-asserted-by":"crossref","first-page":"4020","DOI":"10.3748\/wjg.v12.i25.4020","article-title":"Predicting utility of a model for end stage liver disease in alcoholic liver disease","volume":"12","year":"2006","journal-title":"World J Gastroenterol"},{"key":"hep41786-bib-0003-20241015","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4254\/wjh.v3.i5.108","article-title":"Definition, epidemiology and magnitude of alcoholic hepatitis","volume":"3","year":"2011","journal-title":"World J Hepatol"},{"key":"hep41786-bib-0004-20241015","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1053\/j.gastro.2016.12.019","article-title":"In patients with severe alcoholic hepatitis, prednisolone increases susceptibility to infection and infection\u2010related mortality, and is associated with high circulating levels of bacterial DNA","volume":"152","year":"2017","journal-title":"Gastroenterology"},{"key":"hep41786-bib-0005-20241015","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.cld.2016.02.014","article-title":"Infection and alcoholic liver disease","volume":"20","year":"2016","journal-title":"Clin Liver Dis"},{"key":"hep41786-bib-0006-20241015","first-page":"185","article-title":"Impact of alcohol abuse on the adaptive immune system","volume":"37","year":"2015","journal-title":"Alcohol Res"},{"key":"hep41786-bib-0007-20241015","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":"hep41786-bib-0008-20241015","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":"hep41786-bib-0009-20241015","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":"hep41786-bib-0010-20241015","doi-asserted-by":"crossref","first-page":"567","DOI":"10.4254\/wjh.v9.i12.567","article-title":"Emerging concepts in alcoholic hepatitis","volume":"9","year":"2017","journal-title":"World J Hepatol"},{"key":"hep41786-bib-0011-20241015","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/liv.12939","article-title":"Corticosteroids and occurrence of and mortality from infections in severe alcoholic hepatitis: a meta\u2010analysis of randomized trials","volume":"36","year":"2016","journal-title":"Liver Int"},{"key":"hep41786-bib-0012-20241015","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1055\/s-2007-1007133","article-title":"Pharmacological treatment of portal hypertension: an evidence\u2010based approach","volume":"19","year":"1999","journal-title":"Semin Liver Dis"},{"key":"hep41786-bib-0013-20241015","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":"hep41786-bib-0014-20241015","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1053\/j.gastro.2016.02.042","article-title":"Standard definitions and common data elements for clinical trials in patients with alcoholic hepatitis: recommendation from the NIAAA Alcoholic Hepatitis Consortia","volume":"150","year":"2016","journal-title":"Gastroenterology"},{"key":"hep41786-bib-0016-20241015","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1055\/s-0039-1693402","article-title":"Assessment and management of infection in alcoholic hepatitis","volume":"40","year":"2020","journal-title":"Semin Liver Dis"},{"key":"hep41786-bib-0017-20241015","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.jhep.2019.12.023","article-title":"Long\u2010term outcomes in patients with decompensated alcohol\u2010related liver disease, steatohepatitis and Maddrey\u2019s discriminant function <32","volume":"72","year":"2020","journal-title":"J Hepatol"},{"key":"hep41786-bib-0018-20241015","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jhep.2005.10.013","article-title":"Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies","volume":"44","year":"2006","journal-title":"J Hepatol"},{"key":"hep41786-bib-0019-20241015","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1097\/MEG.0000000000001583","article-title":"Sarcopenia is associated with longer hospital stay and multiorgan dysfunction in alcoholic hepatitis","volume":"32","year":"2020","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"hep41786-bib-0020-20241015","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1053\/j.gastro.2017.02.030","article-title":"Infection in severe alcoholic hepatitis: yet another piece in the puzzle","volume":"152","year":"2017","journal-title":"Gastroenterology"},{"key":"hep41786-bib-0021-20241015","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1002\/hep.20503","article-title":"MELD accurately predicts mortality in patients with alcoholic hepatitis","volume":"41","year":"2005","journal-title":"Hepatology"},{"key":"hep41786-bib-0022-20241015","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40364-015-0046-z","article-title":"Prognostic models for alcoholic hepatitis","volume":"3","year":"2015","journal-title":"Biomark Res"},{"key":"hep41786-bib-0023-20241015","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1002\/hep.30617","article-title":"Biomarkers of macrophage activation and immune danger signals predict clinical outcomes in alcoholic hepatitis","volume":"70","year":"2019","journal-title":"Hepatology"},{"key":"hep41786-bib-0024-20241015","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1053\/j.gastro.2016.12.019","article-title":"In patients with severe alcoholic hepatitis, prednisolone increases susceptibility to infection and infection\u2010related mortality, and is associated with high circulating levels of bacterial DNA","volume":"152","year":"2017","journal-title":"Gastroenterology"}],"container-title":["Hepatology Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hep4.1786","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hep4.1786","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/hep4.1786","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T22:24:16Z","timestamp":1729031056000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/hep4.1786"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,28]]},"references-count":23,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1002\/hep4.1786","relation":{},"ISSN":["2471-254X","2471-254X"],"issn-type":[{"type":"print","value":"2471-254X"},{"type":"electronic","value":"2471-254X"}],"subject":[],"published":{"date-parts":[[2021,7,28]]},"assertion":[{"value":"2021-03-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}