Total SOFA and SOFA Kidney are Associated with Short Term and Long term Outcoming of Sepsis-Associated Liver Injury

Abstract Background: Liver injury is considered as a common complication of sepsis. However, there are still few studies on short-term and long-term prognostic factors of sepsis-associated liver injury (SALI). The objective of our study is to conduct a large sample data cohort study to explore the risk factors for short-term and long-term prognosis of SALI.Methods: Data from a public, US-based, critical-care database (Medical Information Mart for Intensive Care-III [MIMIC-III]) was used. Septic patients who met the definition of acute liver injury were enrolled. Variables extracted from MIMIC-III were used to evaluate patient demographics, clinical characteristics on Day 1 of intensive care unit admission, and clinical outcomes. The Logistic regression models were used to calculate risk ratio (RR) and 95% confidence intervals (CIs) after adjusting for potential factors. Results: Among the 14687 participants in our study, there were 3140 (21.38%) with SALI. SALI was significantly positively associated with ICU mortality (RR, 1.54; 95% CI, 1.32, 1.79), 28-day mortality (RR, 1.27; 95% CI, 1.11, 1.45) and 1-year mortality (RR, 1.19; 95% CI, 1.06, 1.34) after adjusting confounding factors. Stratified by SOFA, there was a positive association between SALI and ICU mortality (RR, 2.15; 95% CI, 1.64, 2.80), 28-day mortality (RR, 1.60; 95% CI, 1.28, 1.99), 1-year mortality (RR, 1.24; 95% CI, 1.04, 1.48) after adjusting confounding factors among people with sofa score ≤ 5. Similar results were also obtained between SALI and ICU mortality (RR,1.40; 95% CI, 1.17, 1.67), 28-day mortality (RR, 1.17; 95% CI, 0.99, 1.38), 1-year mortality (RR, 1.19; 95% CI, 1.02, 1.38) after adjusting confounding factors among people with sofa score> 5. Compared with SOFA renal> 1, SALI had a stronger positive correlation with ICU mortality (RR, 1.36; 95% CI, 1.01, 1.84), 28-day mortality (RR, 1.19; 95% CI, 0.91, 1.56), 1-year mortality (RR, 1.11; 95% CI, 0.88, 1.41) after adjusted confounding factors among people with SOFA renal ≤ 1.Conclusions: SALI was an independent risk factor for ICU mortality, 28-day mortality and 1-year mortality. And there is a close association between liver and kidney in sepsis, but the mechanism is still unclear and requires further study.