Evaluation of the Aspartate Aminotransferase to Platelet Ratio Index for Predicting In-Hospital Mortality in Cardiogenic Shock Patients Admitted to the Intensive Care Unit

Abstract

Backgrounds: This study aimed to investigate the conceivable utility of the aspartate aminotransferase to platelet ratio index (APRI) in prognostic prediction for patients with cardiogenic shock (CS) hospitalized in the intensive care unit (ICU).

Methods: Data for patients diagnosed with CS were obtained from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and categorized into groups based on the APRI quartiles. The primary endpoint encompassed in-hospital and ICU mortality rates. The secondary outcomes included sepsis and acute kidney injury (AKI). Kaplan-Meier survival analysis was utilized to assess differences in main endpoints among groups categorized by their APRI.

Results: This study collected data from 1808 patients diagnosed with CS. Multivariate Cox regression analysis indicated that an elevated APRI was independently correlated with a heightened risk of in-hospital mortality (hazard ratio (HR) 1.005 [95% confidence interval (CI) 1.003-1.007]; p < 0.001) and ICU mortality (HR 1.005 [95% CI 1.003-1.007]; p < 0.001). Multivariate logistic regression analysis demonstrated that APRI was independently correlated with a heightened risk of sepsis (odds ratio (OR) 1.106 [95% CI 1.070-1.144]; p < 0.001) and AKI (OR 1.054 [95% CI 1.035-1.073]; p < 0.001).

Conclusions: An increased APRI was linked to worse clinical outcomes in critically ill patients with cirrhosis. Nevertheless, further extensive prospective investigations are needed to validate these findings.

Keywords: aspartate aminotransferase to platelet ratio index; cardiogenic shock; intensive care unit; predict.

Fig. 1.

A flowchart of this study. MIMIC-IV, Medical Information Mart for Intensive Care-IV; ICU, intensive care unit; AST, aspartate aminotransferase.

Fig. 2.

Kaplan–Meier survival analysis curves of the APRI quartiles for in-hospital (A) and ICU mortality (B). APRI, aspartate aminotransferase to platelet ratio index; ICU, intensive care unit.

Fig. 3.

A forest plot revealed the results of subgroup analysis for in-hospital mortality and ICU mortality based on the APRI value. APRI, aspartate aminotransferase to platelet ratio index; ICU, intensive care unit; HR, hazard ratio; 95% CI, 95% confidence interval; COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure; AF, atrial fibrillation; CKD, chronic kidney disease.

Fig. 4.

The forest plot revealed the results of subgroup analysis for sepsis and acute kidney injury based on the APRI value. APRI, aspartate aminotransferase to platelet ratio index; OR, odds ratio; 95% CI, 95% confidence interval; COPD, chronic obstructive pulmonary disease; AKI, acute kidney injury; CHF, congestive heart failure.