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

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.

Integration Analysis of m6A-SNPs and eQTLs Associated With Sepsis Reveals Platelet Degranulation and Staphylococcus aureus Infection are Mediated by m6A mRNA Methylation

“…Early onset neonatal sepsis can be predicted by platelet/lymphocyte ratio (Arcagok and Karabulut, 2019). A high level of platelet-derived growth factor B (PDGFB) is found in survivors of sepsis (Dou et al, 2019), and PDGFB can reduce the mortality of sepsis by blocking inflammatory responses (Dou et al, 2019). In sepsis-associated liver injury, AST/platelet ratio might be an early onset predictor (Dou et al, 2019).…”

“…A high level of platelet-derived growth factor B (PDGFB) is found in survivors of sepsis (Dou et al, 2019), and PDGFB can reduce the mortality of sepsis by blocking inflammatory responses (Dou et al, 2019). In sepsis-associated liver injury, AST/platelet ratio might be an early onset predictor (Dou et al, 2019). The underlying mechanism of platelet dysfunction in sepsis remains to be elucidated.…”

Total SOFA and SOFA Kidney are Associated with Short Term and Long term Outcoming of Sepsis-Associated Liver Injury

“…Kobashi, H et al [3] demonstrated that the poor prognosis ratio(the proportion of the patients who died or whose condition had worsened or was unchanged)of SALI was 50.6% in a retrospective cohort study. Dou, J et al [11] demonstrated that hospital mortality of pediatric patients with SALI was 23.81%. Y. R. KANG et al [9] demonstrated that ICU mortality in septic shock patients with hepatic dysfunction was 36% and in-hospital mortality was 48% in a retrospective observational study.…”

TLR4-NLRP3-GSDMD-Mediated Pyroptosis Plays an Important Role in Aggravated Liver Injury of CD38-/- Sepsis Mice

“…Clinically, severe bacterial infection can cause septicemia, and sepsis has been recognized as a global health priority by WHO because of the current estimates of 30 million episodes and six million deaths per year [ 1 ]. And the life-threatening organ dysfunction caused by dysregulated host response to infection is a thorny issue in sepsis [ 2 ], including liver injury, one of the main clinical manifestations and an independent risk factor for multiple organ dysfunction syndrome (MODS) and high mortality rate in patients with sepsis [ 3 ]. Hepatic dysfunction is considered to be one component of the MODS and usually associated with a poor prognosis in clinic during sepsis [ 4 ].…”