Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Department of Emergency, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.
BMC Infect Dis. 2024 Oct 10;24(1):1136. doi: 10.1186/s12879-024-10051-6.
The impact of liver fibrosis on the clinical outcomes of patients with sepsis-induced coagulopathy (SIC) is not well understood. This study aimed to evaluate the association between liver fibrosis scores and in-hospital mortality in SIC patients.
In this retrospective observational cohort study, data were collected from patients diagnosed with sepsis and admitted to the ICU at the First Affiliated Hospital of Wenzhou Medical University between January 2017 and December 2023. Liver fibrosis was evaluated using three scores: Fibrosis-4 (Fib-4), Aspartate Aminotransferase-to-Platelet Ratio Index (APRI), and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS). Patients were divided into tertiles according to their liver fibrosis scores, and the primary outcome was in-hospital mortality. Multivariable logistic regression and restricted cubic spline regression analyses were used to assess associations, complemented by sensitivity analyses through subgroup evaluations.
The cohort included 948 patients diagnosed with SIC with an in-hospital mortality of 26.16%. Multivariate logistic regression analysis revealed a significant association between higher liver fibrosis scores and increased in-hospital mortality. Specifically, patients in the highest tertile of Fib-4, APRI, and NFS scores had significantly higher odds of mortality (FIB-4: OR 3.62, 95% CI 1.03-12.69; APRI: OR 2.16, 95% CI 0.88-5.30; NFS: OR 6.80, 95% CI 2.11-21.93) compared to those in the lowest tertile. The restricted cubic spline regression model showed a linear increase in the risk of in-hospital mortality with increasing liver fibrosis score. Sensitivity analysis confirmed the consistency and stability of the results across the different subgroups.
Our study suggests that elevated liver fibrosis scores, particularly Fib-4 and NFS, are associated with higher in-hospital mortality in SIC patients. Further research, especially larger prospective studies, are needed to validate these findings.
肝纤维化对脓毒症诱导的凝血障碍（SIC）患者临床结局的影响尚不清楚。本研究旨在评估 SIC 患者肝纤维化评分与院内死亡率之间的关系。
这是一项回顾性观察性队列研究，数据来自 2017 年 1 月至 2023 年 12 月期间温州医科大学附属第一医院收治的诊断为脓毒症并入住 ICU 的患者。使用三种评分方法评估肝纤维化：纤维化-4 指数（Fib-4）、天门冬氨酸氨基转移酶与血小板比值指数（APRI）和非酒精性脂肪性肝病纤维化评分（NFS）。根据肝纤维化评分将患者分为三分位组，主要结局为院内死亡率。采用多变量逻辑回归和限制立方样条回归分析评估相关性，并通过亚组评估进行敏感性分析。
该队列纳入了 948 例 SIC 患者，院内死亡率为 26.16%。多变量逻辑回归分析显示，肝纤维化评分越高，院内死亡率越高。具体而言，Fib-4、APRI 和 NFS 评分最高三分位组的患者死亡风险显著更高（Fib-4：OR 3.62，95%CI 1.03-12.69；APRI：OR 2.16，95%CI 0.88-5.30；NFS：OR 6.80，95%CI 2.11-21.93），与最低三分位组相比。限制立方样条回归模型显示，随着肝纤维化评分的升高，院内死亡率的风险呈线性增加。敏感性分析证实了不同亚组结果的一致性和稳定性。
本研究表明，升高的肝纤维化评分，特别是 Fib-4 和 NFS，与 SIC 患者的院内死亡率较高相关。需要进一步的研究，特别是更大的前瞻性研究，来验证这些发现。
