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. 2025 Dec;57(1):2438833.
doi: 10.1080/07853890.2024.2438833. Epub 2024 Dec 11.

Prognostic indicators and outcome in patients with acute liver failure, sepsis and with and without shock: a retrospective cohort study

Dan Wang  1 , Xin Wang  1 , Jinsong Mu  1 , Zhidan Kuang  1 , Junchang Zhang  1 , Xianghong Lu  1 , Xuemei Wang  1 , Fang Lin  1
Affiliations

Prognostic indicators and outcome in patients with acute liver failure, sepsis and with and without shock: a retrospective cohort study

Dan Wang et al. Ann Med. 2025 Dec.

Abstract

Background: Sepsis or septic shock is associated with severe morbidity and mortality in patients with acute liver failure (ALF). This study aimed to explore the potential prognostic value of common clinical indicators in patients with ALF, sepsis and with and without shock.

Patients and methods: The clinical, laboratory, and microbiological data of patients with ALF and sepsis or septic shock who were admitted to the intensive care unit from January 2014 to December 2019 were collected retrospectively. Clinical indicators, outcomes and the associations among them were analyzed and defined.

Results: Of 150 patients, 64 (42.7%) and 86 (57.3%) were divided into the shock and non-shock groups, respectively. Plasma procalcitonin (PCT), C-reactive protein (CRP), and creatinine (Cre) levels, aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio, and prothrombin time (PT) in the shock group and plasma PCT and Cre levels in the non-shock group were positively correlated with 30-day, 60-day, and 90-day mortality. Furthermore, plasma ALT levels were positively correlated with 60-day and 90-day mortality, and PTA showed negative correlations with 30-day, 60-day, and 90-day mortality in both groups. Multivariate logistic regression analysis revealed that the combination of plasma PCT and CRP levels, the combination of plasma PCT and ALT levels, and the combination of plasma ALT levels and PTA were found to be associated with 90-day mortality.

Conclusions: Clinical indicators, especially plasma PCT, CRP, and ALT levels, PTA, and their combinations were associated with poor outcomes in patients with ALF, sepsis and with and without shock.

Keywords: Acute liver failure; biochemical parameters; coagulation parameters; inflammatory parameters; mortality; sepsis.

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Conflict of interest statement

The authors report there are no competing interests to declare.

Figures

Figure 1.
Figure 1.
Study flow chart.
Figure 2.
Figure 2.
Comparison of clinical indicators between the shock and non-shock groups. Inflammatory parameters (A) include white blood cell (WBC) and platelet (PLT) counts and plasma procalcitonin (PCT) and C-reactive protein (CRP) levels; biochemical parameters (B) include plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST), direct bilirubin (DBil), total bilirubin (TBil), and creatinine (Cre), levels and levels of blood ammonia (BLA), and blood urea nitrogen (BUN), AST/ALT ratio, and DBil/TBil ratio; coagulation parameters (C) include prothrombin time (PT), prothrombin activity (PTA), and international normalized ratio (INR). *, ** represent p ˂0.05 and p ˂0.01, respectively.
Figure 3.
Figure 3.
30-day, 60-day and 90-day survival curves for patients in the shock and non-shock groups. Black and red lines represent 30-day (a), 60-day (B), and 90-day (C) survival curves for the shock and non-shock groups, respectively.
See this image and copyright information in PMC

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