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Updated: Jan 19, 2026
Evaluation of a Reliable Biomarker in a Cecal Ligation and Puncture-Induced Mouse Model of Sepsis
Published on: December 9, 2022
AST-to-Platelet Ratio Index as Potential Early-Warning Biomarker for Sepsis-Associated Liver Injury in Children: A
Jiaying Dou1, Yiping Zhou1, Yun Cui1
1Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Insights
The AST-to-platelet ratio index (APRI) can predict sepsis-associated liver injury (SALI) in children. An elevated APRI within 24 hours of pediatric intensive care unit admission is a key indicator for SALI.
Area of Science:
- Pediatric critical care medicine
- Hepatology
- Infectious diseases
Background:
- Sepsis-associated liver injury (SALI) is a significant risk factor for poor outcomes in sepsis patients.
- Early identification of SALI is crucial but current biomarkers are insufficient.
- Pediatric patients with sepsis require specific biomarkers for SALI prediction.
Purpose of the Study:
- To identify potential predictors for the occurrence of SALI in pediatric sepsis patients.
- To evaluate the predictive significance of various laboratory variables for SALI.
- To establish early warning biomarkers for SALI in children.
Main Methods:
- Retrospective analysis of a pediatric sepsis database (July 2014 - June 2018).
- Inclusion of patient demographics, comorbidities, and laboratory data from the pediatric intensive care unit (PICU).
- Application of univariate, multivariate logistic, and receiver operating characteristic (ROC) curve analyses.
Main Results:
- The AST-to-platelet ratio index (APRI), gamma-glutamyl transferase (γ-GT), and lactate dehydrogenase (LDH) were identified as independent risk factors for SALI.
- APRI demonstrated strong predictive power for SALI in children (AUC: 0.889), with a sensitivity of 84.6% and specificity of 84.3% at a cutoff of 0.340.
- APRI showed superior performance over LDH and comparable performance to γ-GT in predicting SALI.
Conclusions:
- APRI is an independent risk factor associated with SALI occurrence in pediatric patients.
- An elevated APRI (>0.340) within 24 hours of PICU admission serves as a potential early predictor for SALI in children.
- This finding supports the use of APRI as a valuable biomarker for early SALI detection in pediatric sepsis.
Abstract:
Background: Sepsis-associated liver injury (SALI) is a risk factor of poor outcome in patients with sepsis. The early warning biomarkers for identifying SALI remain poorly defined. Aims: To identify the potential predictors of occurrence of SALI in pediatric patients with sepsis. Methods: We retrospectively analyzed the sepsis database based on the medical records of patients admitted to the pediatric intensive care unit (PICU) in Shanghai Children's Hospital from July 2014 to June 2018. Patients' demographics, co-morbidities and laboratory variables were collected. Univariate and multivariate logistic analysis were used to explore risk factors of SALI, and receiver operating characteristic (ROC) curve analysis was used to evaluate their predictive significances for SALI occurrence. Results: Of 1,645 eligible patients, 1,147 patients were included, and 105 cases had SALI. The indexes including AST-to-platelet ratio index (APRI), γ-GT and lactate dehydrogenase (LDH) were independent risk factors for SALI. Moreover, APRI was powerful to predict SALI in children (AUC: 0.889, 95% CI: 0.851-0.927) with a sensitivity of 84.6 % and a specificity of 84.3 % at the cutoff point of 0.340. APRI was superior to LDH and not inferior to γ-GT for predicting SALI. Conclusion: APRI is an independent risk factor of SALI occurrence, and elevated APRI within 24 h after PICU admission (>0.340) is a potential predictor for SALI in children.
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