LAUSR

INTRODUCTION No study has investigated the association between sub-clinical hepatic fibrosis and sepsis, especially for prognosis. OBJECTIVES Our purpose is to explore the association of liver fibrosis indexes with the outcomes of septic patients without overt chronic liver disease. PATIENTS AND METHODS We performed a cohort study using data extracted from the Medical Information Mart for Intensive Care III (version 1.4). External validation was obtained from the First Affiliated Hospital of Wenzhou Medical University, China. We calculated the aspartate aminotransferase-to-platelet ratio index, fibrosis‑4 (FIB‑4) score, and non-alcoholic fatty liver disease fibrosis score using existing formulas. The primary outcome was 28-day mortality. We assessed the associations of these three indexes with the outcomes using logistic regression analysis. RESULTS In the FIB‑4-sepsis cohort (N = 1560), there was a statistically significant stepwise increase from quartile 1 to quartile 4 in the risk of 28-day mortality (quartile 1: reference; quartile 2: odds ratio [OR] = 1.570, P = 0.06, 95% confidence interval [CI] = 0.980-2.515; quartile 3: OR = 2.363, P < 0.001, 95% CI = 1.512-3.692; quartile 4: OR = 2.933, P < 0.001, 95% CI = 1.895-4.538). The results of multivariable regression analysis, Kaplan-Meier analysis, Cox regression analysis, and external validation exhibited good consistency. CONCLUSIONS The FIB‑4 index is associated with 28-day, 90-day, and in-hospital mortality, and renal replacement therapy in septic patients without overt chronic liver disease. In other words, an advanced stage of sub-clinical hepatic fibrosis as represented by the FIB‑4 score indicates poor outcomes in patients with sepsis.