Palmowski Lars, Westhus Britta, Witowski Andrea, Nowak Hartmuth, Traut Isabella, Canbay Ali, Schnitzbauer Andreas, Elbers Paul, Adamzik Michael, Katsounas Antonios, Rahmel Tim
Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, Bochum 44892, Germany.
Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, Bochum 44892, Germany.
EClinicalMedicine. 2025 Mar 27;82:103173. doi: 10.1016/j.eclinm.2025.103173. eCollection 2025 Apr.
Sepsis-associated liver injury (SALI) is associated with poor outcomes and increased mortality. However, effectively stratifying SALI patients according to prognosis remains challenging. This study evaluates laboratory-based clustering filters for stratifying SALI patients by 30-day mortality risk, utilizing data mining techniques for novel pattern discovery.
This retrospective cohort study analyzed SALI patients from two ICU databases: Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 73,181, study period: 2008 to 2019) and Amsterdam UMC (n = 16,194, study period: 2003 to 2016). Patients were identified using Sepsis-3 criteria and liver injury markers. Risk stratification employed three laboratory-based approaches: (I) De Ritis ratio (aspartate aminotransferase/alanine aminotransferase), (II) R-factor (alanine aminotransferase and alkaline phosphatase relative to their upper limits of normal), and (III) alanine aminotransferase elevation. Kaplan-Meier analysis and multivariable Cox regression assessed the association between stratification methods and 30-day mortality risk.
SALI patients had almost a 2-fold higher risk of 30-day mortality than those without SALI (hazard ratio: 1.73; 95%-CI: 1.58-1.90, p < 0.0001). Each stratification method (I-III) successfully classified patients into statistically distinct risk strata. The De Ritis ratio emerged as the strongest prognostic differentiation method: a ratio ≤1 indicated no significant increase in mortality risk (hazard ratio: 0.86; 95%-CI: 0.68-1.09, p = 0.21), whereas ratios of 1-2 and ≥2 were significantly associated with higher mortality (hazard ratio: 1.56; 95%-CI: 1.37-1.78, p < 0.0001 and hazard ratio: 2.46; 95%-CI: 2.18-2.77, p < 0.0001, respectively). All findings were confirmed in the validation cohort.
The De Ritis ratio serves as a valuable prognostic tool for 30-day mortality in SALI patients. Our findings indicate that patients with a ratio ≥1 face significantly worse outcomes, highlighting the need for targeted interventions. These results refine risk stratification in SALI subphenotypes, enhancing our understanding of its prognostic implications.
This study received no external funding and was solely financed through the departmental resources of the authors.
脓毒症相关肝损伤（SALI）与不良预后及死亡率增加相关。然而，根据预后对SALI患者进行有效分层仍具有挑战性。本研究利用数据挖掘技术发现新模式，评估基于实验室指标的聚类筛选方法，以根据30天死亡风险对SALI患者进行分层。
这项回顾性队列研究分析了来自两个重症监护病房数据库的SALI患者：重症监护医学信息数据库（MIMIC）-IV数据库（n = 73181，研究期：2008年至2019年）和阿姆斯特丹大学医学中心（n = 16194，研究期：2003年至2016年）。使用脓毒症-3标准和肝损伤标志物识别患者。风险分层采用三种基于实验室指标的方法：（I）德瑞蒂斯比值（天冬氨酸转氨酶/丙氨酸转氨酶），（II）R因子（丙氨酸转氨酶和碱性磷酸酶相对于其正常上限），以及（III）丙氨酸转氨酶升高。Kaplan-Meier分析和多变量Cox回归评估分层方法与30天死亡风险之间的关联。
SALI患者30天死亡风险几乎是无SALI患者的2倍（风险比：1.73；95%置信区间：1.58 - 1.90，p < 0.0001）。每种分层方法（I - III）均成功将患者分为统计学上不同的风险层。德瑞蒂斯比值成为最强的预后区分方法：比值≤1表明死亡风险无显著增加（风险比：0.86；95%置信区间：0.68 - 1.09，p = 0.21），而比值为1 - 2和≥2与较高死亡率显著相关（风险比：1.56；95%置信区间：1.37 - 1.78，p < 0.0001和风险比：2.46；95%置信区间：2.18 - 2.77，p < 0.0001）。所有结果在验证队列中得到证实。
德瑞蒂斯比值是SALI患者30天死亡率的有价值的预后工具。我们的研究结果表明，比值≥1的患者预后明显更差，凸显了针对性干预的必要性。这些结果细化了SALI亚表型的风险分层，增强了我们对其预后意义的理解。
本研究未接受外部资金，完全由作者所在部门的资源资助。
Zotero 插件