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Factors Associated with Early Sepsis-Associated Liver Injury and Predictors of 30-Day Mortality: A Retrospective Cohort Study

Year: 2026

Type: article

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.

Source: International Journal of General Medicine

DOI: 10.2147/ijgm.s639020