Admission Liver Enzyme Elevation Grade for Risk Stratification in Critically Ill Patients: Development and Internal...

Area of Science:

• Critical Care Medicine
• Clinical Biochemistry
• Prognostic Biomarkers

Background:

• Liver enzyme abnormalities are frequent in critically ill patients.
• The prognostic significance of graded aminotransferase elevation and its timing is not fully understood.
• Existing scoring systems may not fully capture the prognostic impact of liver enzyme levels.

Purpose of the Study:

• To investigate if Liver Enzyme Elevation (LEE) grade at ICU admission provides prognostic information beyond the Simplified Acute Physiology Score II (SAPS II).
• To assess the association of admission LEE grade with ICU mortality and other clinical outcomes.
• To evaluate the added value of LEE grade to SAPS II for predicting patient outcomes.

Main Methods:

• Retrospective analysis of 274 adult patients admitted to a mixed ICU with ≥72h length of stay.
• Liver Enzyme Elevation (LEE) grade assigned based on AST and ALT levels relative to the upper limit of normal.
• Logistic regression models including SAPS II and admission LEE grade, internally validated using bootstrap resampling.

Main Results:

• ICU mortality was 27.7%. Admission LEE grade showed an adjusted association with ICU mortality (OR 1.26 per grade increase, p=0.048).
• SAPS II remained the dominant predictor (OR 1.04 per point, p<0.001).
• Adding LEE grade to SAPS II slightly improved discrimination (AUC 0.737 vs. 0.703, p=0.039) and was associated with renal replacement therapy and longer ICU stay.

Conclusions:

• Admission LEE grade may offer modest prognostic information complementary to SAPS II in critically ill patients.
• These findings require external validation before clinical implementation.
• Graded liver enzyme elevation could potentially refine risk stratification in intensive care units.