Relationship between aspartate aminotransferase to platelet ratio index and liver injury in pediatric sepsis

Abstract

Background Sepsis-associated liver injury (SALI) is one of the main clinical manifestations of sepsis, as well as an independent risk factor for multiple organ dysfunction syndrome and mortality in pediatric sepsis. The early warning biomarkers for identifying SALI remain poorly defined. Objective To analyze the relationship between aspartate amino-transferase to platelet ratio index (APRi) and liver injury occurrence in pediatric sepsis, as well as determine the APRi cut-off value for early identification of SALI. Methods This retrospective study used secondary data derived from January 2019 to August 2020. The study population comprised admitted children aged 1 month to <18 years who met the criteria for sepsis, and had aspartate aminotransferase (AST) and platelet laboratory parameters checked in the first 24 hours of sepsis and before administration of antibiotics. Pearson’s Chi-square test was used to analyze for correlations. Estimation of the APRi cut-off value in the early occurence of SALI was performed with logistic regression analysis and receiver operating characteristic (ROC) curve. Results Of the 112 subjects, 94.6% were categorized as having septic shock and 48.2% had SALI. Logistic regression revealed that APRi was a significant predictor of SALI, as indicated by cut-off 4.726 [OR 1.098; 95%CI 1.002 to1.203; P=0.045]. The area under the curve (AUC) was 0.831 or 83.1%. Conclusion The APRi is a reliable early predictor of SALI in pediatric sepsis, as indicated by an increase in APRi (> 4.726) within the first 24 hours of sepsis. [Paediatr Indones. 2021;61:149-54;.