ArticleEClinicalMedicine2025
Subphenotypes and the De Ritis ratio for mortality risk stratification in sepsis-associated acute liver injury: a retrospective cohort study.
Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Association Between Lactate Trajectories and Clinical Outcomes in Critically Ill Patients with Sepsis-Associated Liver Injury.Journal of clinical medicine · 2026Article
- Sepsis-associated liver injury: from liver-test risk signals to immunobiology-guided precision medicine.Intensive care medicine · 2026Article
- Development and validation of clinical phenotypes in sepsis-associated liver injury using multi-algorithm consensus classification: a retrospective cohort study.BMC infectious diseases · 2026Article
- Initial Aspartate Aminotransferase-to-platelet Ratio Index is Associated with Sepsis-associated Liver Dysfunction in Adult Patients with Sepsis: A Retrospective Cohort Study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- A non-linear association between AST/ALT ratio and 28-day mortality in critically ill elderly: evidence from a multicenter study.Scientific reports · 2025Article
- HNF4α contributes to hepatic CAR dysfunction in polymicrobial sepsis.Frontiers in immunology · 2025Article
- Sesamoside Alleviates Inflammatory Response in Septic Shock-Associated Acute Liver Injury by Modulating the NF-κB/MAPK Signaling Pathway.Dose-response : a publication of International Hormesis SocietyArticle
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11 authors.
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Abstract
Background: Sepsis-associated liver injury (SALI) is associated with poor outcomes and increased mortality. However, effectively stratifying SALI patients according to prognosis remains challenging. This study evaluates laboratory-based clustering filters for stratifying SALI patients by 30-day mortality risk, utilizing data mining techniques for novel pattern discovery. Methods: This retrospective cohort study analyzed SALI patients from two ICU databases: Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 73,181, study period: 2008 to 2019) and Amsterdam UMC (n = 16,194, study period: 2003 to 2016). Patients were identified using Sepsis-3 criteria and liver injury markers. Risk stratification employed three laboratory-based approaches: (I) De Ritis ratio (aspartate aminotransferase/alanine aminotransferase), (II) R-factor (alanine aminotransferase and alkaline phosphatase relative to their upper limits of normal), and (III) alanine aminotransferase elevation. Kaplan-Meier analysis and multivariable Cox regression assessed the association between stratification methods and 30-day mortality risk. Findings: SALI patients had almost a 2-fold higher risk of 30-day mortality than those without SALI (hazard ratio: 1.73; 95%-CI: 1.58-1.90, p < 0.0001). Each stratification method (I-III) successfully classified patients into statistically distinct risk strata. The De Ritis ratio emerged as the strongest prognostic differentiation method: a ratio ≤1 indicated no significant increase in mortality risk (hazard ratio: 0.86; 95%-CI: 0.68-1.09, p = 0.21), whereas ratios of 1-2 and ≥2 were significantly associated with higher mortality (hazard ratio: 1.56; 95%-CI: 1.37-1.78, p < 0.0001 and hazard ratio: 2.46; 95%-CI: 2.18-2.77, p < 0.0001, respectively). All findings were confirmed in the validation cohort. Interpretation: The De Ritis ratio serves as a valuable prognostic tool for 30-day mortality in SALI patients. Our findings indicate that patients with a ratio ≥1 face significantly worse outcomes, highlighting the need for targeted interventions. These results refine risk stratification in SALI subphenotypes, enhancing our understanding of its prognostic implications. Funding: This study received no external funding and was solely financed through the departmental resources of the authors.
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