Boyacı Dündar Nazlıhan, İnci Kamil, Aygencel Gülbin, Türkoğlu Melda, Gökçe Onur, Cindoruk Mehmet
Department of Internal Medicine, Division of Intensive Care Medicine, Gazi University School of Medicine, Ankara, Türkiye.
Yunus Emre State Hospital, Eskişehir, Türkiye.
Turk J Gastroenterol. 2025 Jun 16;36(9):600-608. doi: 10.5152/tjg.2025.24794.
BACKGROUND/AIMS: Septic patients with chronic liver disease (CLD) experience high morbidity and mortality rates, particularly in the intensive care unit (ICU) setting, due to immune dysfunction. Despite their vulnerability, data on prognostic markers remain scarce, particularly when assessed in conjunction with disease severity scores. This study aimed to evaluate the prognostic value of various inflammatory markers, including white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), lactate, and lactate-to-albumin ratio (LAR), in septic critically ill CLD patients.
A retrospective cohort study was conducted on 126 septic CLD patients admitted to ICU. Data on demographics, clinical scores, inflammatory markers, and clinical outcomes were collected. Logistic regression and ROC analyses were used to identify independent predictors of ICU mortality.
Intensive care unit mortality was 66%. In addition to higher Acute Physiology and Chronic Health Evaluation II (APACHE II) (39.3 ± 7.2 vs. 21 ± 5.1, P < .001), Sequential Organ Failure Assessment (12.4 ± 3.5 vs. 8.5 ± 3.1, P < .001), CLIF-C ACLF [63 (54-69) vs. 50 (41- 53)] scores, ICU non-survivors had higher WBC (median: 14 400/µL vs. 7300/µL, P < .001), lactate (median: 4.6mmol/L vs. 2.4mmol/L, P < .001), NLR (median: 12.5 vs. 9, P = .015), and LAR (median: 2.15 vs. 0.93, P < .001) compared to survivors. Multivariate analysis identified APACHE II (OR 1.183, 95% CI: 1.003-1.396, P = .046), CLIF-C ACLF (OR 1.104, 95% CI: 1.002-1.216, P = .046), and LAR (OR 2.992, 95% CI: 1.277-7.009, P = .012) as independent predictors of ICU mortality. The LAR was the most significant inflammatory marker (area under the curve: 0.783, cut-off: 1.17), even in the subgroup of patients with low acute decompensation scores based on the CLIF-C ACLF score.
The LAR was a valuable prognostic marker for ICU mortality in septic CLD patients, even in the absence of advanced organ failure. This marker potentially outperforms other traditional inflammatory markers and could aid in early risk stratification for critically ill septic CLD patients.
背景/目的：慢性肝病（CLD）脓毒症患者由于免疫功能障碍，发病率和死亡率都很高，尤其是在重症监护病房（ICU）。尽管他们很脆弱，但关于预后标志物的数据仍然很少，特别是与疾病严重程度评分一起评估时。本研究旨在评估各种炎症标志物，包括白细胞计数（WBC）、中性粒细胞与淋巴细胞比值（NLR）、乳酸和乳酸与白蛋白比值（LAR），在脓毒症重症CLD患者中的预后价值。
对126例入住ICU的脓毒症CLD患者进行回顾性队列研究。收集了人口统计学、临床评分、炎症标志物和临床结局的数据。采用逻辑回归和ROC分析来确定ICU死亡率的独立预测因素。
ICU死亡率为66%。除了急性生理与慢性健康状况评估II（APACHE II）评分更高（39.3±7.2对21±5.1，P<.001）、序贯器官衰竭评估（SOFA）评分更高（12.4±3.5对8.5±3.1，P<.001）、CLIF-C ACLF评分更高[63（54 - 69）对50（41 - 53）]外，与幸存者相比，ICU非幸存者的WBC更高（中位数：14400/µL对7300/µL，P<.001）、乳酸更高（中位数：4.6mmol/L对2.4mmol/L，P<.001）、NLR更高（中位数：12.5对9，P = .015）以及LAR更高（中位数：2.15对0.93，P<.001）。多因素分析确定APACHE II（比值比1.183，95%置信区间：1.003 - 1.396，P = .046）、CLIF-C ACLF（比值比1.104，95%置信区间：1.002 - 1.216，P = .046）和LAR（比值比2.992，95%置信区间：1.277 - 7.009，P = .012）是ICU死亡率的独立预测因素。即使在基于CLIF-C ACLF评分的急性失代偿评分较低的患者亚组中，LAR也是最显著的炎症标志物（曲线下面积：0.783，截断值：1.17）。
LAR是脓毒症CLD患者ICU死亡率的有价值的预后标志物，即使在没有晚期器官衰竭的情况下也是如此。该标志物可能优于其他传统炎症标志物，并有助于对重症脓毒症CLD患者进行早期风险分层。
