Early Joint Trajectories of Liver-Related Laboratory Biomarkers and 60-Day Mortality in Sepsis-Associated Liver Injury
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Background
Sepsis-associated liver injury (SALI) is commonly assessed using static laboratory values, although liver dysfunction during sepsis is dynamic.
Methods
This retrospective cohort study included 162 ICU patients with SALI. Early trajectories of alanine aminotransferase, total bilirubin, and albumin during the first 7 days after ICU admission were identified using group-based multi-trajectory modeling. Landmark analysis and Cox regression were used to evaluate 60-day mortality.
Results
Twenty-five patients died within 60 days. Four trajectory classes were identified. Between-class separation was driven mainly by alanine aminotransferase and total bilirubin, whereas albumin showed limited short-term variation. After the landmark time point, Class 3 (HR, 4.374; 95% CI, 1.960-9.759; P <0 .001) and Class 4 (HR, 7.451; 95% CI, 3.649-15.212; P <0 .001) had higher mortality risk than Class 1.
Conclusions
Early joint trajectories of liver-related laboratory biomarkers may identify clinically meaningful SALI subphenotypes and support risk stratification in critically ill patients.
