天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值与ICU患者28天死亡率的关联：一项来自MIMIC-IV数据库的回顾性队列研究。

Association between aspartate aminotransferase to alanine aminotransferase ratio and 28-day mortality of ICU patients: A retrospective cohort study from MIMIC-IV database.

作者信息

Wang Yanping, Xu Yan

机构信息

Department of Pharmacy, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.

出版信息

PLoS One. 2025 May 23;20(5):e0324904. doi: 10.1371/journal.pone.0324904. eCollection 2025.

DOI:10.1371/journal.pone.0324904

PMID:40408358

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12101646/

Abstract

BACKGROUND

Prior studies have linked the aspartate aminotransferase to alanine aminotransferase ratio (AAR) with negative health outcomes in the elderly and specific populations. However, the impact of AAR on the prognosis of the entire population in the intensive care unit (ICU) remains unclear. This study aimed to determine the correlation between AAR and the mortality among adult ICU patients.

METHOD

Patient data were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and stratified into quartiles by AAR. Survival analysis using the Kaplan-Meier curves was conducted to compare survival across quartiles. The primary outcome was 28-day mortality, with secondary outcomes including 60-day, 90-day, and 365-day mortality, along with ICU-free, ventilator-free, and vasopressor-free days within the first 28 days. The association between AAR and mortality was evaluated using Cox proportional hazards regression analysis complemented by a restricted cubic spline. Furthermore, the eICU Collaborative Research Database (eICU-CRD) was used as an external validation cohort for sensitivity analysis.

RESULT

The study included 20,225 patients with a mean age of 63.7 ± 17.5 years. Kaplan-Meier analysis indicated a higher risk of 28-day mortality for patients with higher AAR (log-rank P < 0.001). After adjusting for confounders, the AAR was significantly related to 28-day mortality (HR = 1.04, 95% CI: 1.03-1.06, P < 0.001) and other mortality benchmarks, exhibiting an inverted L-shaped relationship. The inflection point of the AAR for 28-day mortality was 2.60. Below this threshold, each unit increase in the AAR was associated with a 19% rise in the risk of 28-day mortality (HR = 1.19, 95% CI: 1.11-1.27, P < 0.001), with a plateau observed above this threshold. Subgroup and sensitivity analyses further confirmed the robustness and generalizability of the study.

CONCLUSION

AAR demonstrated a significant association with 28-day, 60-day, 90-day, and 365-day mortality, characterized by an inverted L-shaped pattern.

摘要

背景

先前的研究已将天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值（AAR）与老年人及特定人群的不良健康结局联系起来。然而，AAR对重症监护病房（ICU）全体人群预后的影响仍不清楚。本研究旨在确定AAR与成年ICU患者死亡率之间的相关性。

方法

从重症监护医学信息数据库IV（MIMIC-IV）中检索患者数据，并按AAR分层为四分位数。采用Kaplan-Meier曲线进行生存分析，以比较各四分位数的生存率。主要结局为28天死亡率，次要结局包括60天、90天和365天死亡率，以及前28天内无ICU、无呼吸机和无血管活性药物支持的天数。使用Cox比例风险回归分析并辅以受限立方样条评估AAR与死亡率之间的关联。此外，使用电子ICU协作研究数据库（eICU-CRD）作为外部验证队列进行敏感性分析。

结果

该研究纳入了20225例患者，平均年龄为63.7±17.5岁。Kaplan-Meier分析表明，AAR较高的患者28天死亡率风险更高（对数秩检验P<0.001）。在调整混杂因素后，AAR与28天死亡率（HR=1.04，95%CI：1.03-1.06，P<0.001）及其他死亡率基准显著相关，呈现倒L形关系。28天死亡率的AAR拐点为2.60。低于此阈值，AAR每增加一个单位，28天死亡率风险增加19%（HR=1.19，95%CI：1.11-1.27，P<0.001），高于此阈值则观察到平台期。亚组分析和敏感性分析进一步证实了该研究的稳健性和可推广性。