Table_1_AST-to-Platelet Ratio Index as Potential Early-Warning Biomarker for Sepsis-Associated Liver Injury in Children: A Database Study.XLS

Background: Sepsis-associated liver injury (SALI) is a risk factor of poor outcome in patients with sepsis. The early warning biomarkers for identifying SALI remain poorly defined.
Aims: To identify the potential predictors of occurrence of SALI in pediatric patients with sepsis.
Methods: We retrospectively analyzed the sepsis database based on the medical records of patients admitted to the pediatric intensive care unit (PICU) in Shanghai Children's Hospital from July 2014 to June 2018. Patients' demographics, co-morbidities and laboratory variables were collected. Univariate and multivariate logistic analysis were used to explore risk factors of SALI, and receiver operating characteristic (ROC) curve analysis was used to evaluate their predictive significances for SALI occurrence.
Results: Of 1,645 eligible patients, 1,147 patients were included, and 105 cases had SALI. The indexes including AST-to-platelet ratio index (APRI), γ-GT and lactate dehydrogenase (LDH) were independent risk factors for SALI. Moreover, APRI was powerful to predict SALI in children (AUC: 0.889, 95% CI: 0.851–0.927) with a sensitivity of 84.6 % and a specificity of 84.3 % at the cutoff point of 0.340. APRI was superior to LDH and not inferior to γ-GT for predicting SALI.
Conclusion: APRI is an independent risk factor of SALI occurrence, and elevated APRI within 24 h after PICU admission (>0.340) is a potential predictor for SALI in children.

背景：脓毒症相关性肝损伤（Sepsis-associated liver injury, SALI）是脓毒症患者预后不良的危险因素，目前用于识别SALI的早期预警生物标志物仍未明确。
研究目的：旨在明确儿童脓毒症患者发生SALI的潜在预测因子。
方法：本研究回顾性分析2014年7月至2018年6月上海儿童医院儿科重症监护室（pediatric intensive care unit, PICU）收治患者的医疗记录构建的脓毒症数据库，收集患者的人口学资料、合并症及实验室变量。采用单因素及多因素logistic回归分析探究SALI的危险因素，并通过受试者工作特征（receiver operating characteristic, ROC）曲线分析评估各指标对SALI发生的预测价值。
结果：在1645例符合入组标准的患者中，最终纳入1147例，其中105例发生SALI。天冬氨酸转氨酶-血小板比值指数（AST-to-platelet ratio index, APRI）、γ-谷氨酰转移酶（γ-GT）及乳酸脱氢酶（lactate dehydrogenase, LDH）为SALI的独立危险因素。此外，APRI对儿童SALI具有良好的预测效能（曲线下面积AUC: 0.889，95%置信区间CI: 0.851–0.927），在临界值0.340时，其灵敏度为84.6%，特异度为84.3%。APRI预测SALI的效能优于LDH，且不劣于γ-GT。
结论：APRI是儿童脓毒症相关性肝损伤发生的独立危险因素，患儿于PICU收治后24小时内APRI升高（>0.340）可作为儿童SALI的潜在预测指标。