Choi Sungwoo, Nah Sangun, Suh Gil Joon, Choi Sung-Hyuk, Chung Sung Phil, Kim Won Young, Lim Tae Ho, Choi Sangchun, Shin Tae Gun, Han Sangsoo
Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea.
Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Diagnostics (Basel). 2025 Jul 14;15(14):1773. doi: 10.3390/diagnostics15141773.
: Sepsis is a leading cause of mortality. The AST/ALT ratio may serve as a valuable marker for prediction in patients with various diseases. This study analyzed the prognostic value of this ratio in patients with sepsis. : A retrospective analysis was performed on data from a prospective registry of septic shock patients, collected across multiple centers from October 2015 to December 2022. The main outcome of interest was mortality within 28 days. We evaluated the predictive accuracy of 28-day mortality for variables with the Sequential Organ Failure Assessment (SOFA) score, aspartate transaminase (AST) levels, alanine transaminase (ALT) levels, the AST/ALT ratio, and the combination of the SOFA + AST/ALT ratio using the area under the receiver operating characteristics curve (AUROC). A Kaplan-Meier curve was used to compare the 28-day mortality between the AST/ALT subgroups (≥1.84 and <1.84). Stepwise multivariable Cox proportional hazards analyses were performed to determine the association between 28-day mortality and an AST/ALT ratio ≥ 1.84. : The AST/ALT ratio had a significantly higher discriminatory ability for predicting 28-day mortality compared to either AST or ALT. In addition, combining the AST/ALT ratio with the SOFA score improved the predictive accuracy compared to the SOFA alone. A multivariable Cox regression analysis demonstrated that an AST/ALT ratio ≥ 1.84 was associated with a higher risk of death within 28 days. : The AST/ALT ratio at emergency department admission in sepsis patients is associated with 28-day mortality and, when combined with the SOFA score, provides additional prognostic information with moderate accuracy.
脓毒症是主要的死亡原因。谷草转氨酶/谷丙转氨酶（AST/ALT）比值可能是各类疾病患者预后预测的重要指标。本研究分析了该比值在脓毒症患者中的预后价值。：对2015年10月至2022年12月多个中心收集的脓毒性休克患者前瞻性登记数据进行回顾性分析。主要关注的结局是28天内的死亡率。我们使用受试者工作特征曲线下面积（AUROC）评估序贯器官衰竭评估（SOFA）评分、天冬氨酸转氨酶（AST）水平、丙氨酸转氨酶（ALT）水平、AST/ALT比值以及SOFA + AST/ALT比值组合对28天死亡率的预测准确性。采用Kaplan-Meier曲线比较AST/ALT亚组（≥1.84和<1.84）之间的28天死亡率。进行逐步多变量Cox比例风险分析以确定28天死亡率与AST/ALT比值≥1.84之间的关联。：与AST或ALT相比，AST/ALT比值对预测28天死亡率具有显著更高的判别能力。此外，与单独使用SOFA评分相比，将AST/ALT比值与SOFA评分相结合可提高预测准确性。多变量Cox回归分析表明，AST/ALT比值≥1.84与28天内更高的死亡风险相关。：脓毒症患者急诊入院时的AST/ALT比值与28天死亡率相关，与SOFA评分相结合时，可提供具有中等准确性的额外预后信息。
