Wang Min, Li Yun, Cao Yuan, Yang Meng-Meng, Liu Fu-Jing, Jiao Jie, Wang Sheng-Yuan, Song Bin, Wang Lu, Wu Yi-Qi, Kang Hong-Jun
Medical School of Chinese PLA, Beijing, China.
Department of Critical Care Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
Ann Med. 2025 Dec;57(1):2478485. doi: 10.1080/07853890.2025.2478485. Epub 2025 Mar 15.
The aspartate aminotransferase-to-platelet ratio index (APRI) is an effective non-invasive marker for chronic liver dysfunction. Given that heat stroke patients often suffer from poor prognosis due to multi-organ involvement, with liver injury and coagulation dysfunction being of particular concern, this study aims to investigate whether APRI can comprehensively reflect liver injury and coagulation dysfunction in heat stroke patients and explore its relationship with 28-day mortality.
This retrospective study analysed electronic medical records from patients treated at 57 grade A tertiary hospitals in China from May 2005 to May 2024. The primary outcome was 28-day mortality, and the secondary outcome was 7-day mortality. Restricted cubic splines (RCS) were utilized to visualize the relationship between APRI and 28-day mortality risk. The independent association between APRI and outcomes was assessed using Cox proportional hazards models, with multivariable analyses controlling for confounding factors. The predictive ability of APRI for outcomes was evaluated using receiver operating characteristic (ROC) curves.
A total of 450 eligible patients were included, with 71 deaths occurring within 28 days. RCS analysis showed a positive correlation between APRI and 28-day mortality. Participants were divided into higher (APRI ≥ 15.14) and lower (APRI < 15.14) APRI groups. Cox proportional hazards models indicated that individuals with higher APRI had a significantly increased 28-day mortality rate (HR 5.322, 95% confidence interval [CI] 2.642-10.720, < 0.0001). Subgroup and interaction analyses confirmed the robustness of the core findings. Additionally, the areas under the ROC (AUROC) for APRI predicting 28-day mortality was 0.823 (95% CI 0.772-0.875), significantly higher than the AST to ALT ratio (0.526, 95% CI 0.448-0.605) and total bilirubin (0.694, 95% CI 0.623-0.765).
APRI is an independent predictor of early mortality risk in heat stroke.
天冬氨酸氨基转移酶与血小板比值指数（APRI）是慢性肝功能不全的一种有效的非侵入性标志物。鉴于中暑患者常因多器官受累而预后不良，其中肝损伤和凝血功能障碍尤为值得关注，本研究旨在探讨APRI是否能全面反映中暑患者的肝损伤和凝血功能障碍，并探究其与28天死亡率的关系。
这项回顾性研究分析了2005年5月至2024年5月在中国57家三级甲等医院接受治疗的患者的电子病历。主要结局是28天死亡率，次要结局是7天死亡率。采用限制立方样条（RCS）来直观呈现APRI与28天死亡风险之间的关系。使用Cox比例风险模型评估APRI与结局之间的独立关联，并进行多变量分析以控制混杂因素。使用受试者工作特征（ROC）曲线评估APRI对结局的预测能力。
共纳入450例符合条件的患者，其中71例在28天内死亡。RCS分析显示APRI与28天死亡率呈正相关。参与者被分为APRI较高（APRI≥15.14）和较低（APRI<15.14）两组。Cox比例风险模型表明，APRI较高的个体28天死亡率显著增加（风险比5.322，95%置信区间[CI]2.642-10.720，P<0.0001）。亚组分析和交互作用分析证实了核心研究结果的稳健性。此外，APRI预测28天死亡率的ROC曲线下面积（AUROC）为0.823（95%CI 0.772-0.875），显著高于谷草转氨酶与谷丙转氨酶比值（0.526，95%CI 0.448-0.605）和总胆红素（0.694，95%CI 0.623-0.765）。
APRI是中暑早期死亡风险的独立预测指标。
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