Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2024; 16(11): 1255-1264
Published online Nov 27, 2024. doi: 10.4254/wjh.v16.i11.1255
Diagnostic value of tissue plasminogen activator-inhibitor complex in sepsis-induced liver injury: A single-center retrospective case-control study
Ye Zhou, Long-Ping He, Ying-Han Qi, Yu Huang, Bing-Qin Hu, Jia-Ling Liu, Qing-Bo Zeng, Jing-Chun Song
Ye Zhou, Long-Ping He, Ying-Han Qi, Yu Huang, Bing-Qin Hu, Jia-Ling Liu, Jing-Chun Song, Department of Critical Care Medicine, Changcheng Hospital Affiliated to Nanchang University, Nanchang 330002, Jiangxi Province, China
Ye Zhou, Jing-Chun Song, Department of Critical Care Medicine, The 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force, Nanchang 330002, Jiangxi Province, China
Qing-Bo Zeng, Intensive Care Unit, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330002, Jiangxi Province, China
Author contributions: Zhou Y drafted the manuscript; Zhou Y, He LP, and Zeng QB contributed to the statistical analysis; He LP, Qi YH, Huang Y, Hu BQ, and Liu JL participated in the acquisition of data; Song JC revised the manuscript. All authors read and approved the final manuscript.
Supported by National Key R&D Program of China, No. 2022YFC2304600.
Institutional review board statement: This study was approved by the Ethics Committee of the 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force, No. 908yyLL028.
Informed consent statement: As patients or their legal guardians signed a written consent form upon admission, agreeing to disclose their anonymous medical data for research purposes, no informed consent was required for this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Chun Song, MD, PhD, Chief Physician, Department of Critical Care Medicine, Changcheng Hospital Affiliated to Nanchang University, No. 1028 Jinggangshan Road, Nanchang 330002, Jiangxi Province, China. songjingchun@126.com
Received: April 14, 2024
Revised: September 5, 2024
Accepted: October 15, 2024
Published online: November 27, 2024
Processing time: 206 Days and 1.5 Hours
Abstract
BACKGROUND

Sepsis often causes severe liver injury and leads to poor patient outcomes. Early detection of sepsis-induced liver injury (SILI) and early treatment are key to improving outcomes.

AIM

To investigate the clinical characteristics of SILI patients and analyze the associated risk factors, to identify potential sensitive biomarkers.

METHODS

Retrospective analysis of clinical data from 546 patients with sepsis treated in the intensive care unit of the 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force between May 2018 and December 2022. The patients were divided into the sepsis group (n = 373) and SILI group (n = 173) based on the presence of acute liver injury within 2 hours of admission. We used the random forest algorithm to analyze risk factors and assessed potential diagnostic markers of SILI using the area under the receiver operating characteristic curve, Kaplan-Meier survival curves, subgroup analysis and correlation analysis.

RESULTS

Compared with the sepsis group, tissue plasminogen activator-inhibitor complex (t-PAIC) levels in serum were significantly higher in the SILI group (P < 0.05). Random forest results showed that t-PAIC was an independent risk factor for SILI, with an area under the receiver operating characteristic curve of 0.862 (95% confidence interval: 0.832-0.892). Based on the optimal cut-off value of 11.9 ng/mL, patients at or above this threshold had significantly higher levels of lactate and Acute Physiology and Chronic Health Evaluation II score. The survival rate of these patients was also significantly worse (hazard ratio = 2.2, 95% confidence interval: 1.584-3.119, P < 0.001). Spearman’s correlation coefficients were 0.42 between t-PAIC and lactate, and 0.41 between t-PAIC and aspartate transaminase. Subgroup analysis showed significant differences in t-PAIC levels between patients with different severity of liver dysfunction.

CONCLUSION

T-PAIC can serve as a diagnostic indicator for SILI, with its elevation correlated with the severity of SILI.

Keywords: Sepsis; Liver injury; Liver diseases; Tissue plasminogen activator-inhibitor complex; Prognosis

Core Tip: Our study showed that tissue plasminogen activator-inhibitor complex levels were significantly higher in patients with sepsis-induced liver injury and differed significantly between patients with different severity of liver dysfunction. Furthermore, our study proposed that tissue plasminogen activator-inhibitor complex may be an effective biomarker for diagnosis of sepsis-induced liver injury, providing a novel tool for its clinical recognition.