Factors Associated with Early Sepsis-Associated Liver Injury and Predictors of 30-Day Mortality: A Retrospective Cohort Study.
8 affiliations
- 1Division of Intensive Care Medicine, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Türkiye.
- 2Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Türkiye.
- 3Department of Clinical Biochemistry, Faculty of Medicine, Ege University, Izmir, Türkiye.
- 4Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Türkiye.
- 5Division of Endocrinology and Metabolism, Department of Internal Medicine, Bursa City Hospital, Bursa, Türkiye.
- 6Department of Internal Medicine, Izmir Atatürk Training and Research Hospital, Izmir, Türkiye.
- 7Faculty of Medicine, Ege University, Izmir, Türkiye.
- 8Department of Internal Medicine, Faculty of Medicine, Bandırma Onyedi Eylül University, Balıkesir, Türkiye.
Abstract
Background
Sepsis-associated liver injury (SALI) is associated with higher mortality, but the factors associated with early SALI and the determinants of mortality in patients with SALI remain incompletely understood.Methods
This retrospective cohort study included 524 consecutive patients with sepsis (Sepsis-3) in a tertiary intensive care unit (ICU). SALI was defined as total bilirubin ≥2 mg/dL with international normalized ratio ≥1.5, or alanine aminotransferase ≥68 U/L (twice the local upper limit of normal), within 24 hours of ICU admission. Factors independently associated with SALI and with 30-day mortality in SALI were identified by logistic regression after multiple imputation and elastic-net selection, with bootstrap internal validation.Results
Of 523 evaluable patients, 135 (25.8%) met the SALI definition, and their 30-day mortality was higher (63.4% vs 50.0%, p=0.010). Factors independently associated with SALI were macrophage activation-like syndrome (MALS) (aOR: 5.33), an abdominal focus (aOR: 4.03), disseminated intravascular coagulation (DIC) score ≥5 (aOR: 3.07), acute kidney injury on admission (aOR: 2.29) and log-ferritin (aOR: 1.31; 1.48 without MALS and DIC) (all p<0.05; optimism-corrected area under the curve [AUC]: 0.770). Among patients with SALI, immunosuppressive therapy (OR: 8.13), a thoracic focus (OR: 8.62), log-ferritin (OR: 2.04) and activated partial thromboplastin time (aPTT) (OR: 1.08 per second) were independently associated with 30-day mortality (all p<0.05); appropriate antibiotic therapy showed a non-significant protective trend (p=0.076). The mortality model showed good discrimination (optimism-corrected AUC: 0.857) but limited calibration (slope: 0.562).Conclusion
SALI was associated with higher 30-day mortality in sepsis. Because the factors associated with SALI were assessed concurrently with liver injury, they describe its clinical profile rather than predict its development. Immunosuppressive therapy, a thoracic focus, higher ferritin levels and prolonged aPTT were associated with 30-day mortality in SALI. These findings should be interpreted with caution and require external validation.
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BibTeX
@article{kurtulmus2026factors,
title = {{Factors Associated with Early Sepsis-Associated Liver Injury and Predictors of 30-Day Mortality: A Retrospective Cohort Study.}},
author = {İlkce Akgun Kurtulmus and Sukriye Miray Kilincer Bozgul and Caner Acar and Gunes Ak and Rabia Ozmen and Hande Dik Avcı and Merve Dogru Efgan and Cagrı Uslu and Zehra Tuba Karaman and Devrim Bozkurt},
journal = {International journal of general medicine},
year = {2026},
month = oct,
doi = {10.2147/ijgm.s639020},
url = {https://europepmc.org/article/MED/42928790},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Factors Associated with Early Sepsis-Associated Liver Injury and Predictors of 30-Day Mortality: A Retrospective Cohort Study.
AU - İlkce Akgun Kurtulmus
AU - Sukriye Miray Kilincer Bozgul
AU - Caner Acar
AU - Gunes Ak
AU - Rabia Ozmen
AU - Hande Dik Avcı
AU - Merve Dogru Efgan
AU - Cagrı Uslu
AU - Zehra Tuba Karaman
AU - Devrim Bozkurt
PY - 2026
DA - 2026/10/21
JO - International journal of general medicine
DO - 10.2147/ijgm.s639020
UR - https://europepmc.org/article/MED/42928790
AB - Background Sepsis-associated liver injury (SALI) is associated with higher mortality, but the factors associated with early SALI and the determinants of mortality in patients with SALI remain incompletely understood.Methods This retrospective cohort study included 524 consecutive patients with sepsis (Sepsis-3) in a tertiary intensive care unit (ICU). SALI was defined as total bilirubin ≥2 mg/dL with international normalized ratio ≥1.5, or alanine aminotransferase ≥68 U/L (twice the local upper limit of normal), within 24 hours of ICU admission. Factors independently associated with SALI and with 30-day mortality in SALI were identified by logistic regression after multiple imputation and elastic-net selection, with bootstrap internal validation.Results Of 523 evaluable patients, 135 (25.8%) met the SALI definition, and their 30-day mortality was higher (63.4% vs 50.0%, p=0.010). Factors independently associated with SALI were macrophage activation-like syndrome (MALS) (aOR: 5.33), an abdominal focus (aOR: 4.03), disseminated intravascular coagulation (DIC) score ≥5 (aOR: 3.07), acute kidney injury on admission (aOR: 2.29) and log-ferritin (aOR: 1.31; 1.48 without MALS and DIC) (all p<0.05; optimism-corrected area under the curve [AUC]: 0.770). Among patients with SALI, immunosuppressive therapy (OR: 8.13), a thoracic focus (OR: 8.62), log-ferritin (OR: 2.04) and activated partial thromboplastin time (aPTT) (OR: 1.08 per second) were independently associated with 30-day mortality (all p<0.05); appropriate antibiotic therapy showed a non-significant protective trend (p=0.076). The mortality model showed good discrimination (optimism-corrected AUC: 0.857) but limited calibration (slope: 0.562).Conclusion SALI was associated with higher 30-day mortality in sepsis. Because the factors associated with SALI were assessed concurrently with liver injury, they describe its clinical profile rather than predict its development. Immunosuppressive therapy, a thoracic focus, higher ferritin levels and prolonged aPTT were associated with 30-day mortality in SALI. These findings should be interpreted with caution and require external validation.
SN - 1178-7074
ER -