The aspartate transaminase to platelet ratio index(APRI) as a risk factor and predictor for sepsis-associated liver injury in children

Abstract

Objective To investigate the association and predictive value of aspartate transaminase to platelet ratio index(APRI) in sepsis-associated liver injury(SALI). Methods We retrospectively analyzed the medical records of patients with sepsis admitted to PICU in Shanghai Children′s Hospital of Shanghai Jiaotong University from April 2015 to March 2017.According to whether liver injury occurred in the sepsis patients during hospitalization, all the patients were divided into SALI group(n=34) and sepsis group(n=222). The clinical characteristics, serological indexes within 24 hours in the PICU, and the ratio of aspartate transaminase to alanine transaminase(AAR) and APRI were collected and analyzed.The receiver operating characteristic(ROC) curve was used to evaluate the power of APRI for the prediction of SALI. Results (1)A total of 256 patients were enrolled in this study.There were 34 cases with SALI, and there were 222 patients with sepsis only, the incidence of SALI was 13.3%.(2)The values of APRI and AAR were both higher in the SALI group compared with the sepsis group[APRI: 7.12(1.71, 26.96) vs.0.38(0.21, 0.83), P<0.001; AAR: 1.43(0.94, 2.69) vs.2.17(1.35, 2.96), P<0.05]. (3)The multivariate Logistic regression analysis showed that total bilirubin, APRI, AAR and platelet were the independent risk factors of SALI(P<0.05). (4)In addition, the area under the ROC curve(AUC)for the APRI was 0.891(95%CI 0.815-0.966, P<0.001), cut-off value was 1.73, which was superior to total bilirubin(AUC=0.744, 95%CI 0.634-0.853, P<0.001) and platelet(AUC=0.726, 95%CI 0.611-0.841, P<0.001). The clinical sensitivity and specificity of the APRI for identification of SALI from sepsis was 80.0% and 92.2%, respectively. Conclusion APRI is an independently risk factor for the occurrence of SALI and is a precursory marker for SALI. Key words: Serological indexes; Aspartate transaminase to platelet ratio index; Sepsis; Sepsis-associated liver injury; Children