Predictive Value Of PLR,APRI And FIB In Septic Acute Hepatic Injury

Purpose:To explore the predictive value of platelet-to-lymphocyte ratio(PLR),aspartate aminotransferase-to-platelet ratio(APRI)and fibrinogen(FIB)in sepsis patients acute hepatic injury(s-AHI)methods:This experiment is a single-center retrospective study.Collect the relevant data of sepsis patients hospitalized in the emergency intensive care unit(EICU)and intensive care unit(ICU)of Qingdao Municipal Hospital from June 2020 to May 2022.Clinical data of 192 patients were collected.According to the occurrence of acute hepatic injury,they were divided into S-AHI group and N-AHI group,with 73 cases(38%)in S-AHI group and 119 cases(62%)in N-AHI group;According to the classification criteria of sepsis hepatic injury,the S-AHI group was divided into mild S-AHI group(22 cases(11.5%),moderate S-AHI group(15 cases(8%),and severe S-AHI group(36 cases(18.8%);Record the routine clinical information of patients with sepsis after admission,such as age,sex,vital signs,whether there is underlying disease,infection site,whether there is shock,whether there is death,Collect the laboratory test indicators of the enrolled patients within 24 hours of admission,including blood routine,procalcitonin(PCT),hematocrit(HCT),blood gas analysis related indicators,total bilirubin(T-BIL),FIB,alkaline phosphatase(ALP),liver enzyme indicators such as alanine aminotransferase(ALT)Aspartate aminotransferase(AST),sequential organ failure(SOFA)score,acute physical and chronic health(APACHE II)score,PLR and APRI within 24 hours of admission were calculated.Wilcoxon signed rank test was used to compare the indexes of S-AHI group and N-AHI group;Spearman correlation analysis was used to study the correlation between PLR,APRI,FIB and relevant indicators in S-AHI group;The indicators of each group of S-AHI were compared by Kru Skal-Wali S H method,and the significant indicators between the groups were compared by boferroni correction;The independent predictors of S-AHI were explored by single factor and binary logistic regression;Make receiver operating characteristic(ROC)curve,and calculate the area under the curve.(P<0.05);result:1.There were differences in age,heart rate,shock and death between S-AHI group and N-AHI group(P<0.05);Monocyte,platelet(Platelet,PLT),oxygenation index,FIB and PLR in S-AHI group were lower than those in N-AHI group,The scores of inhaled oxygen concentration,TBIL,ALP,ALT,AST,APRI,SOFA and APACHE II in S-AHI group were higher than those in N-AHI group(P<0.05);2.Correlation analysis of research indicators in S-AHI group: PLR was moderately negatively correlated with lymphocytes,and moderately positively correlated with platelet count(P<0.05);APRI was weakly positively correlated with heart rate and moderately negatively correlated with platelet(P<0.05);FIB was weakly positively correlated with blood potassium(P<0.05).3.Comparison of indexes of different injury degrees in S-AHI group: there are differences in hematocrit,lactic acid,TBIL,FIB,PLR,APRI(P<0.05);Among them,moderate TBIL is lower than severe,and severe hematocrit,lactic acid,TBIL,FIB,PLR,APRI are higher than mild(P<0.05);4.Single factor and binary logistic regression analysis showed that:PLR,APRI,ALT,TBIL can be used as independent predictors of sepsis AHI,while FIB cannot be used as independent predictors of sepsis AHI;The area under curve(AUC)of PLR for predicting AHI in sepsis was 0.597,P<0.001,95% CI was 0.513-0.681,sensitivity50.1%,specificity 89.9%;APRI can predict the area under curve(AUC)of sepsis AHI is0.690,P<0.05,95% CI is 0.612-0.767,sensitivity is 71.2%,specificity is 63.9%.The area under curve(AUC)of ALT for predicting AHI in sepsis was 0.862,P<0.001,95%CI was 0.804-0.919,sensitivity was 71%,specificity was 91.6%;TBIL can predict the area under curve(AUC)of sepsis AHI is 0.776,P<0.001,95% CI is 0.701-0.850,sensitivity is 49.3%,specificity is 98.3%.Conclusion:1.PLR and APRI have certain predictive value for the occurrence of acute hepatic injury in sepsis.2.ALT and TBIL can predict the occurrence of acute hepatic injury in sepsis.It can be used as an independent predictor of acute hepatic injury in patients with sepsis,and guide clinical workers to timely detect,prevent and adjust treatment plans.3.FIB can not predict the occurrence of acute hepatic injury in sepsis and can not be used as an independent predictor of the occurrence of acute hepatic injury in sepsis.However,FIB in the severe S-AHI group shows a downward trend and can be used as an effective indicator of the severity of the disease.