International Normalized Ratio to Albumin Ratio (PTAR): An Objective Risk Stratification Tool in Patients with Sepsis

Sepsis is a life-threatening multiple-organ dysfunction caused by dysregulation of host response to severe infection. Liver failure is a validated independent predictor of mortality. Accurate and rapid assessment of liver function is critical in patients with sepsis. However, an appropriate scoring system for liver function requires further development.

Our study aimed to validate the usefulness of the prothrombin time-international normalized ratio (PT-INR) to albumin ratio (PTAR) in predicting the mortality of patients with sepsis.

Data on a total of 4536 patients, obtained from the Multiparameter Intelligent Monitoring in Intensive Care III database, were included in our retrospective study. Logistic regression, Poisson regression with robust variance estimate analysis, and Cox proportional hazards models were used to explore the relationship between PTAR and mortality. Area under the curve (AUC) and decision curve analysis (DCA) were used to estimate the performance of PTAR in predicting the prognosis in septic patient.

Multivariable Poisson regression showed that the relative risk (RR) of PTAR to ICU mortality, hospital mortality, and 28-day and 90-day mortality in septic patients was 1.26 (95% CI: 1.15-1.37), 1.24 (95% CI: 1.15-1.34), 1.23 (95% CI: 1.15-1.31), and 1.21 (95% CI: 1.13-1.28), respectively. Multivariable Cox regression showed that the hazard ratio (HR) of PTAR to 28-day mortality and 90-day mortality was 1.56 (95% CI: 1.44-1.70), and 1.55 (95% CI: 1.43-1.68), respectively. PTAR showed a moderate discrimination capacity in predicting hospital mortality (AUC: 0.655, 95% CI: 0.636-0.675) and 90-day mortality (AUC: 0.650, 95% CI: 0.633-0.667).

The PTAR scoring system is a convenient tool for predicting the prognosis of patients with sepsis.