Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
Scand J Gastroenterol. 2023 Apr;58(4):392-402. doi: 10.1080/00365521.2022.2131331. Epub 2022 Oct 18.
The study investigates the diagnostic and prognostic value of the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio in patients with sepsis and septic shock. Limited data regarding the prognostic value of the AST/ALT ratio in patients suffering from sepsis or septic shock is available.
Consecutive patients with sepsis and septic shock from 2019 to 2021 were included monocentrically. Blood samples were retrieved from day of disease onset (day 1), day 2, 3, 5 and 7. First, the diagnostic value of the AST/ALT ratio was tested for septic shock compared to sepsis. Second, the prognostic value of the AST/ALT ratio was tested for 30-d all-cause mortality. Statistical analyses included univariable -test, Spearman's correlation, C-statistics, Kaplan-Meier analyses, as well as multivariable mixed analysis of variance (ANOVA), Cox proportional regression analyses and propensity score matching.
A total of 289 patients were included, of which 55% had sepsis and 45% septic shock. The overall rate of all-cause mortality at 30 d was 53%. With an area under the curve (AUC) of 0.651 on day 1 and 0.794 on day 7, the AST/ALT ratio revealed moderate but better diagnostic discrimination of septic shock compared to bilirubin. Furthermore, the AST/ALT ratio was able to discriminate 30-d all-cause mortality (AUC = 0.624; 95% CI 0.559 - 0.689; = 0.001). Patients with an AST/ALT ratio above the median (>1.8) had higher rates of 30-d all-cause mortality compared to lower values (mortality rate 63 . 43%; log-rank = 0.001), even after multivariable adjustment (HR = 1.703; 95% CI 1.182 - 2.453; = 0.004) and propensity score matching.
The AST/ALT was a reliable diagnostic tool for the diagnosis of septic shock as well as a reliable tool to predict 30-d all-cause mortality in patients suffering from sepsis and septic shock.
本研究旨在探讨天门冬氨酸氨基转移酶（AST）与丙氨酸氨基转移酶（ALT）比值在脓毒症和脓毒性休克患者中的诊断和预后价值。目前关于 AST/ALT 比值在脓毒症或脓毒性休克患者中的预后价值的数据有限。
本研究为单中心、连续性研究，纳入了 2019 年至 2021 年脓毒症和脓毒性休克患者。采集患者发病第 1 天、第 2、3、5 和 7 天的血样。首先，比较 AST/ALT 比值对脓毒性休克的诊断价值与脓毒症。其次，测试 AST/ALT 比值对 30 天全因死亡率的预后价值。统计分析包括单变量 t 检验、Spearman 相关分析、C 统计量、Kaplan-Meier 分析以及多变量混合方差分析（ANOVA）、Cox 比例回归分析和倾向评分匹配。
共纳入 289 例患者，其中 55%为脓毒症，45%为脓毒性休克。30 天全因死亡率为 53%。第 1 天和第 7 天 AST/ALT 比值的曲线下面积（AUC）分别为 0.651 和 0.794，表明其对脓毒性休克的诊断具有中等但更好的区分能力，优于胆红素。此外，AST/ALT 比值能够区分 30 天全因死亡率（AUC=0.624；95%CI 0.559-0.689；P=0.001）。AST/ALT 比值高于中位数（>1.8）的患者 30 天全因死亡率高于比值较低的患者（死亡率为 63.43%；log-rank=0.001），即使在多变量调整后（HR=1.703；95%CI 1.182-2.453；P=0.004）和倾向评分匹配后也是如此。
AST/ALT 比值不仅是诊断脓毒性休克的可靠工具，也是预测脓毒症和脓毒性休克患者 30 天全因死亡率的可靠工具。
