Initial Aspartate Aminotransferase-to-platelet Ratio Index is Associated with Sepsis-associated Liver Dysfunction in...

Sepsis-associated liver dysfunction (SALD) represents a prevalent and critical complication frequently observed in patients with sepsis. The association between the initial aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI) and SALD is unclear in adult patients diagnosed with sepsis.

We retrospectively analyzed data from the Medical Information Mart for Intensive Care-IV database. Sepsis-associated liver dysfunction was defined as an elevated serum aminotransaminase (>800 IU/L) or total bilirubin (>2 mg/dL) level. Multivariate and smoothing curve analyses were performed to investigate the relationship between the APRI [APRI = (AST (IU/L)/upper limits of normal)/PLT (k/uL)×100] and SALD. Subgroup analysis was additionally conducted to assess the robustness of the finding. Receiver operating characteristic (ROC) curve was performed to evaluate the discriminatory ability of SALD. External validation was performed using our own dataset.

Overall, 6,334 sepsis patients (SALD, n = 985; no-SALD, n = 5,349) were included. Initial APRI was positively associated with SALD occurrence after controlling for potential confounding variables [odds ratio (OR) = 1.17; 95% confidence interval (CI): 1.15-1.20; p < 0.001]. A nonlinear dose-dependent relationship was found between initial APRI and SALD (p < 0.001). Subgroup analysis revealed no significant interaction between initial APRI and each subgroup divided by age, sex, albumin level, and Sequential Organ Failure Assessment score (p > 0.05). The area under the curve (AUC) for APRI was 0.769 (95% CI: 0.752-0.786), and the optimal cutoff was 0.95. External validation also exhibited good consistency (AUC: 0.761; 95% CI: 0.680-0.842).

A high initial APRI was linked to an elevated risk of developing SALD in adult patients with sepsis, as shown by the non-linear dose-dependent relationship.

Initial APRI is an easy and accessible tool that can be adopted for timely detection of the risk of SALD and prompt initiation of interventions for adult patients with sepsis.

Zhang B, Li X, Qin Z, Dong D, Yu W. Initial Aspartate Aminotransferase-to-platelet Ratio Index is Associated with Sepsis-associated Liver Dysfunction in Adult Patients with Sepsis: A Retrospective Cohort Study. Indian J Crit Care Med 2025;29(11):916-924.