Clinical Features And Mortality Risk Factors Of Sepsis-associated Liver Injury:A Retrospective Study

Objective To understand the clinical characteristics of patients with sepsis-associated liver injury in our hospital,and to identify the risk factors for the occurrence and poor prognosis.Methods This study was a single-center,retrospective observational study.collecting sepsis patients who met the inclusion and exclusion criteria in the emergency ICU and critical care medicine department of affiliated hospital of qinghai university from November 2019 to December 2021.The patients with sepsis were divided into two subgroups according to whether there was liver injury: liver injury group and non-liver injury group,to analyzed the clinical characteristics and risk factors of patients with sepsis-associated liver injury.patients with sepsis-associated liver injury were divided into two groups according to the outcome of patients during hospitalization: survival group and death group,to analyzed the prognostic risk factors of sepsis-associated liver injury.according to the clinical characteristics of patients with liver injury,they were divided into three subgroups: high total bilirubin group,high alanine aminotransferase group,high total bilirubin and high alanine aminotransferase group,and analyzed the differences between the three groups in the time of liver injury,the duration of liver injury,the recovery rate and prognosis etc.Results 1.In this study,119 patients with sepsis were collected,including 64(53.78%)patients with liver injury and 27(41.5%)patients died from liver injury.2.The results of univariate analysis in sepsis liver injury group and non liver injury group showed that: age,gender,mechanical ventilation,the number of multiple organ dysfunction,sequential organ failure assessment(SOFA score),acute physiology and chronic health evaluation-II(APACHE-II score),aspartate aminotransferase/platelet ratio index(APRI),P<0.05,the difference was statistically significant;Multivariate logistic analysis showed that age,gender,SOFA score and MODS were independent risk factors.3.Using alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),APRI,mean platelet volume/platelet(MPV/PLT)and platelet/white blood cell(PLT/WBC)to predict liver injury in patients with sepsis,The results showed that the values of ALT,AST,TBIL and APRI were all less than0.05.The combined diagnosis of ALT,AST,TBIL and APRI had a larger area under the curve and higher sensitivity and specificity compared with a single index.4.To analysis of prognostic factors of patients with sepsis-associated liver injury showed that: age,shock,mechanical ventilation,multiple organ dysfunction syndrome(MODS),lactic acid(Lac),SOFA score,APACHE-II score,APRI and length of hospital stay,P<0.05;Multivariate logistic analysis showed that mechanical ventilation and Lac were independent risk factors for poor prognosis in patients with sepsis-associated liver injury,and the length of hospital stay was its protective factor.5.The patients with sepsis-associated liver injury were divided into three groups: high total bilirubin group,high alanine aminotransferase group,high total bilirubin and high alanine aminotransferase group.The mortality were 42.1%(8/19),25.0%(6/24)and 61.9%(13/21)respectively.The comparison between subgroups was p=0.044.The recovery of liver function at discharge was 9 cases(47.4%),17 cases(70.8%)and 8 cases(38.1%),respectively.The recovery rate of high alanine aminotransferase group was the highest.The incidence of MODS was 47.4%(9/19),29.2%(7/24)and76.2%(16/21),respectively(P =0.07).The median SOFA score was 7.79,7.46 and10.95 respectively,P =0.009.Conclusion 1.Male,age,SOFA score,and MODS are independent risk factors for sepsis-associated liver injury.2.Mechanical ventilation and Lac are independent risk factors for poor prognosis in sepsis-associated liver injury.3.ALT,AST,TBIL,and APRI can all diagnose sepsis-associated liver injury,and the combined diagnosis of the four is more effective.4.Among the types of sepsis-associated liver injury,Compared with high total bilirubin group and high alanine aminotransferase group,high total bilirubin and high alanine aminotransferase group had lower recovery rate of liver function,higher mortality and poorer prognosis.