AST-to-Platelet Ratio Index as Potential Early-Warning Biomarker for Sepsis-Associated Liver Injury in Children: A Database Study.

Jiaying Dou,Chunxia Wang,Yun Cui,Yiping Zhou,Yucai Zhang,Min Chen

doi:10.3389/fped.2019.00331

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.

Highlights

Sepsis is a leading cause for admission to pediatric intensive care unit (PICU), and it is life-threatening organ dysfunction caused by dysregulated host response to infection [1]
The incidence rate of severe sepsis or septic shock was significantly higher in the Sepsis-associated liver injury (SALI) group compared with the sepsis group (24.76 vs. 8.06 %, P < 0.001; 24.76 vs. 12.0 %, P < 0.001, respectively)
This is the first report that AST-to-platelet ratio index (APRI) is an early predictor of warning for SALI occurrence

Summary

Introduction

Sepsis is a leading cause for admission to pediatric intensive care unit (PICU), and it is life-threatening organ dysfunction caused by dysregulated host response to infection [1]. Sepsis-associated liver injury (SALI) is one of the main clinical performances, which is an independent risk factor for multiple organ dysfunction and high mortality rate in pediatric patients with sepsis [2, 3]. Warning and appropriate treatment of liver injury is critical for recovery in patients with sepsis. Role of APRI in Sepsis-Associated Liver Injury. Systemic inflammatory response, persistent microcirculatory failure, or even undesirable side effects of the treatment provided may be main causes of liver failure [4]. Neither TBIL nor ALT could early identify the occurrence of liver injury. Zagory et al [6] found that the cut-off value of ALT had the possibility of over-predicting low risk liver injury in children with trauma. 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

Methods

Results

Discussion

Conclusion