Peng Hongye, Zheng Tao, Zeng Na, Han Yating, Niu Zuohu, Wang Yu, Duan Shaojie
Beijing University of Chinese Medicine, Beijing, China.
Shaodong People's Hospital, Hunan Province, China.
BMC Gastroenterol. 2025 May 7;25(1):339. doi: 10.1186/s12876-025-03931-x.
Cirrhosis is the end stage of many chronic liver diseases, which seriously affects the quality of life of patients. The alkaline phosphatase to albumin ratio (APAR) index is a new indicator related to the prognostic risk of many diseases. This study was aimed at exploring the association between the APAR index and the risk of all-cause mortality in patients with cirrhosis.
Patients with cirrhosis who were 18 years of age or older and admitted to the intensive care unit were included from the Medical Information Mart for Intensive Care IV (MIMIC-IV) - Version 3.0 database in this study. The primary endpoint of this study was all-cause mortality at 365- days, with secondary endpoints at 90-days and 28-days after admission. The hazard ratio (HR) and 95% CI between the APAR index and endpoints were calculated using the Cox proportional hazards model. A restricted cubic spline (RCS) regression model was created to explore the relationship between the APAR index and cirrhosis. Furthermore, we explored the predictive value of the APAR index in different populations of cirrhosis through subgroup analysis.
A total of 2,109 patients with cirrhosis were included from the MIMIC-IV database. After adjusting for potential covariates, APAR as a continuous variable was significantly positively associated with all-cause mortality at 28-days (HR: 2.007, 95% CI: 1.369, 2.948; P < 0.001), 90-days (HR: 2.392, 95% CI: 1.642, 3.495; P < 0.001), and 365-days (HR: 2.418, 95% CI: 1.660, 3.534; P < 0.001) in cirrhotic patients. When APAR was a categorical variable, compared with patients in the lower APAR group, the risk of 365-days all-cause mortality in patients of the higher APAR group significantly increased (HR: 1.451, 95%CI: 1.197, 1.758). APAR was linearly related to all-cause mortality at 28-days, 90-days and 365-days after admission (P for non-linearity = 0.221, 0.390, and 0.344, respectively). Subgroup analysis indicated that among patients with cirrhosis complicated with hepatorenal syndrome, those without spontaneous peritonitis or portal hypertension/esophageal varices, and those receiving human albumin infusion, elevated APAR levels were significantly associated with an increased risk of long-term death.
A higher APAR index is significantly associated with the risk of all-cause mortality in cirrhosis. APAR may be a potential biomarker for evaluating the long-term prognosis of critically ill patients with cirrhosis.
肝硬化是许多慢性肝病的终末期，严重影响患者的生活质量。碱性磷酸酶与白蛋白比值（APAR）指数是一种与多种疾病预后风险相关的新指标。本研究旨在探讨APAR指数与肝硬化患者全因死亡风险之间的关联。
本研究纳入了年龄在18岁及以上、入住重症监护病房的肝硬化患者，数据来自重症监护医学信息集市IV（MIMIC-IV）-3.0版数据库。本研究的主要终点是365天的全因死亡率，次要终点是入院后90天和28天的全因死亡率。使用Cox比例风险模型计算APAR指数与终点之间的风险比（HR）和95%置信区间（CI）。创建受限立方样条（RCS）回归模型以探讨APAR指数与肝硬化之间的关系。此外，我们通过亚组分析探讨了APAR指数在不同肝硬化患者群体中的预测价值。
MIMIC-IV数据库共纳入2109例肝硬化患者。在调整潜在协变量后，作为连续变量的APAR与肝硬化患者28天（HR：2.007，95%CI：1.369，2.948；P＜0.001）、90天（HR：2.392，95%CI：1.642，3.495；P＜0.001）和365天（HR：2.418，95%CI：1.660，3.534；P＜0.001）的全因死亡率显著正相关。当APAR为分类变量时，与低APAR组患者相比，高APAR组患者365天全因死亡风险显著增加（HR：1.451，95%CI：1.197，1.758）。APAR与入院后28天、90天和365天的全因死亡率呈线性相关（非线性P值分别为0.221、0.390和0.344）。亚组分析表明，在合并肝肾综合征、无自发性腹膜炎或门静脉高压/食管静脉曲张以及接受人血白蛋白输注的肝硬化患者中，APAR水平升高与长期死亡风险增加显著相关。
较高的APAR指数与肝硬化患者的全因死亡风险显著相关。APAR可能是评估肝硬化重症患者长期预后的潜在生物标志物。
