Relationship between aspartate aminotransferase to platelet ratio index and liver injury in pediatric sepsis

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Robby Godlief
Dzulfikar Djalil Lukmanul Hakim
Dwi Prasetyo


Background Sepsis-associated liver injury (SALI) is one of the main clinical manifestations of sepsis, as well as an independent risk factor for multiple organ dysfunction syndrome and mortality in pediatric sepsis. The early warning biomarkers for identifying SALI remain poorly defined.

Objective To analyze the relationship between aspartate aminotransferase to platelet ratio index (APRi) and liver injury occurrence in pediatric sepsis, as well as determine the APRi cutoff value for early identification of SALI.

Methods This retrospective study used secondary data derived from January 2019 to August 2020. The study population comprised admitted children aged 1 month to <18 years who met the criteria for sepsis, and had aspartate aminotransferase (AST) and platelet laboratory parameters checked in the first 24 hours of sepsis and before administration of antibiotics. Pearson’s Chi-square test was used to analyze for correlations. Estimation of the APRi cutoff value in the early occurrence of SALI was performed with logistic regression analysis and receiver operating characteristic (ROC) curve.

Results Of the 112 subjects, 94.6% were categorized as having septic shock and 48.2% had SALI. Logistic regression revealed that APRi was a significant predictor of SALI, as indicated by cut-off 4.726 [OR 1.098; 95%CI 1.002 to1.203; P=0.045]. The area under the curve (AUC) was 0.831 or 83.1%, which was classified as strong (80-90%).

Conclusion The APRi is a reliable early predictor of SALI in pediatric sepsis, as indicated by an increase in APRi (> 4.726) within the first 24 hours of sepsis.

Article Details

How to Cite
Godlief R, Hakim D, Prasetyo D. Relationship between aspartate aminotransferase to platelet ratio index and liver injury in pediatric sepsis. PI [Internet]. 21Jun.2021 [cited 25Jul.2021];61(3):149-. Available from:
Emergency & Pediatric Intensive Care
Received 2021-03-03
Accepted 2021-06-21
Published 2021-06-21


1. Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. 2020;21:e52–106. doi: 10.1097/PCC.0000000000002198.
2. Peryoga SU, Hudaya D, Alam A. The correlation of arterial lactate level and base excess with disease severity on PELOD-2 score in pediatric sepsis. Pediatr Crit Care Med. 2018;19:114. doi: 10.1097/01.pcc.0000537676.61689.b3.
3. Yan J, Li S, Li S. The role of the liver in sepsis. Int Rev Immunol. 2014;33:498–510. doi: 10.3109/08830185.2014.889129.
4. Goldstein B, Giroir B, Randolph A. International Pediatric Sepsis Consensus Conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2–8. doi: 10.1097/01.PCC.0000149131.72248.E6.
5. Dou J, Zhou Y, Cui Y, Chen M, Wang C, Zhang Y. AST-to-platelet ratio index as potential early-warning biomarker for sepsis-associated liver injury in children: a database study. Front Pediatr. 2019;7:331. doi: 10.3389/fped.2019.00331. Pincus MR, Tierno P, Dufour DR. Evaluation of liver function. In: McPherson RA, Pincus MR. Henry’s clininal diagnosis and management by laboratory methods. 21st ed. Elsevier: Shanghai; 2011. p. 296–311.
6. Unlusoy-Aksu A, Sari S, Yilmaz G, Egritas-Gurkan O, Demitras Z, Dalgic B. Aspartate aminotransferase-to-platelet ratio index in children with cholestatic liver diseases to assess liver fibrosis. Turk J Pediatr. 2015;57:492–7. PMID: 27411417.
7. Grieve A, Makin E, Davenport M. Aspartate aminotransferase-to-platelet ratio index (APRi) in infants with biliary atresia: prognostic value at presentation. J Pediatr Surg. 2013;48:789–95. doi: 10.1016/j.jpedsurg.2012.10.010.
8. Hwang JH, Chung ML. Predictive value of the aspartate aminotransferase to platelet ratio index for parenteral nutrition associated cholestasis in extremely low birth weight infants. BMC Pediatr. 2019;19:126. doi: 10.1186/s12887-019-1493-8.
9. Cruz AT, Lane RD, Balamuth F, Aronson PL, Do DWA, Neuman MI, et al. Updates on pediatric sepsis. J Am Coll Emerg Physicians Open. 2020;1:981–93. doi: 10.1002/emp2.12173.
10. Randolph AG, McCulloh RJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence. 2014;5:172–82. doi: 10.4161/viru.27045.
11. Matics TJ, Sanchez-Pinto LN. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the Sepsis-3 definitions in critically ill children. JAMA Pediatr. 2017;171:e172352. doi: 10.1001/ jamapediatrics.2017.2352.
12. Wang D, Yin Y, Yao Y. Advances in sepsis-associated liver dysfunction. Burns Trauma. 2014;2:97-105. doi: 10.4103/2321-3868.132689.
13. Limdi JK, Hyde GM. Evaluation of abnormal liver function tests. Postgrad Med J. 2003;79:307–12. DOI: 10.1136/pmj.79.932.307.