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Xia W, Hua X, Sun D, Xie X, Hu H. Albumin-to-alkaline phosphatase ratio as a novel prognostic indicator in patients undergoing peritoneal dialysis: a propensity score matching analysis. Front Med (Lausanne) 2024; 11:1302603. [PMID: 38698782 PMCID: PMC11063294 DOI: 10.3389/fmed.2024.1302603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Background Though the albumin-to-alkaline phosphatase ratio (AAPR) is used as a biomarker in various diseases, little is known about its effect on outcomes after peritoneal dialysis (PD). Methods This multicenter retrospective study comprised 357 incident PD patients stratified according to the AAPR. Propensity score matching (PSM) was performed to identify 85 patients for a well-matched comparison of all-cause and cardiovascular mortality. Using Cox regression, we performed univariate and multivariate analyses to investigate the prognostic value of the AAPR and established a Kaplan-Meier curve-predicted nomogram to estimate expected overall survival (OS). We assessed the predictive accuracy using the concordance index (c-index). Results We found that the optimal cut-off of the AAPR to predict mortality was 0.36. In the present cohort of patients undergoing PD, a low AAPR strongly correlated with worse OS. In the multivariate analysis, the AAPR was shown to be an independent marker predicting reduced OS both before [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.08-2.60, P = 0.020] and after PSM (HR 1.96, 95% CI 1.06-3.62, P = 0.020). We also observed significant differences in OS in several subgroups, but not the group of patients with comorbidities. A nomogram was established to predict overall survival, with a c-index for prediction accuracy was 0.71 after PSM. Conclusion AAPR has potential as an independent prognostic biomarker in patients undergoing PD.
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Affiliation(s)
- Wenkai Xia
- Department of Nephrology, Jiangyin People's Hospital Affiliated to Nantong University, Jiangyin, China
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Xi Hua
- Department of Nephrology, Affiliated Hospital of Yangzhou University, Yangzhou First People's Hospital, Yangzhou, China
| | - Dong Sun
- Department of Nephrology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiangcheng Xie
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hong Hu
- Department of Nephrology, Jiangyin People's Hospital Affiliated to Nantong University, Jiangyin, China
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Lai X, Chen H, Dong X, Zhou G, Liang D, Xu F, Liu H, Luo Y, Liu H, Wan S. AST to ALT ratio as a prospective risk predictor for liver cirrhosis in patients with chronic HBV infection. Eur J Gastroenterol Hepatol 2024; 36:338-344. [PMID: 38251454 PMCID: PMC10833202 DOI: 10.1097/meg.0000000000002708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/19/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) is one of the most frequent indicators to discriminate fibrosis and cirrhosis. However, the results remained controversial. The aim of this study was to evaluate the predictive effect of AAR on hepatitis B virus (HBV)-related cirrhosis development. METHOD A retrospective cohort study was conducted based on 1754 chronic HBV-infected patients. Clinical variables at their initial visit and follow-up data were collected. Cox proportional hazards model was constructed to evaluate the predictive value of AAR on cirrhosis risk, and its discrimination accuracy was determined by receiver operating characteristic (ROC). The time-dependent effect was assessed by a Fine and Gray competing risk model. RESULTS Compared to patients with lower AAR, those with elevated AAR level had higher risk of cirrhosis development by adjusting for host characteristics (dichotomized analyses: hazard ratio = 2.77, P = 8.25 × 10 -4 ; tertile analyses: hazard ratio = 2.95, P = 1.61 × 10 -3 ), with an increasing risk trend ( Ptrend = 4.56 × 10 -4 ). The effect remained prominent when ALT or AST was abnormal, while no significant risk was observed when AST and ALT were simultaneously normal. Time-dependent effect analysis demonstrated a persistently higher risk, with the average hazard ratio equivalent to 1.92. AAR level could improve the discrimination efficacy of host variables with area under the curve increased from 0.684 to 0.711 ( P = 0.039 ). CONCLUSION Higher AAR was significantly associated with increased risk of HBV-related cirrhosis, and might be a potential predictor of cirrhosis development.
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Affiliation(s)
- Xiaohuan Lai
- Institute of Hepatology, Department of Hepatology, The Affiliated Fifth People’s Hospital of Ganzhou, Gannan Medical University
| | - Haiyan Chen
- Center for Molecular Pathology, Department of Basic Medicine, Gannan Medical University, Ganzhou
| | - Xiaofeng Dong
- Department of Infectious Disease, No. 988 Hospital of Joint Logistic Support Force, The Chinese People’s Liberation Army, Zhengzhou, China
| | - Guanlin Zhou
- Institute of Hepatology, Department of Hepatology, The Affiliated Fifth People’s Hospital of Ganzhou, Gannan Medical University
| | - Dong Liang
- Department of Infectious Disease, No. 988 Hospital of Joint Logistic Support Force, The Chinese People’s Liberation Army, Zhengzhou, China
| | - Fei Xu
- Institute of Hepatology, Department of Hepatology, The Affiliated Fifth People’s Hospital of Ganzhou, Gannan Medical University
| | - Hongxia Liu
- Institute of Hepatology, Department of Hepatology, The Affiliated Fifth People’s Hospital of Ganzhou, Gannan Medical University
| | - Yingmin Luo
- Institute of Hepatology, Department of Hepatology, The Affiliated Fifth People’s Hospital of Ganzhou, Gannan Medical University
| | - Hui Liu
- Institute of Hepatology, Department of Hepatology, The Affiliated Fifth People’s Hospital of Ganzhou, Gannan Medical University
| | - Shaogui Wan
- Institute of Hepatology, Department of Hepatology, The Affiliated Fifth People’s Hospital of Ganzhou, Gannan Medical University
- Center for Molecular Pathology, Department of Basic Medicine, Gannan Medical University, Ganzhou
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Liu S, Zhao K, Shao C, Xu L, Cui X, Wang Y. Association between alkaline phosphatase to albumin ratio and mortality among patients with sepsis. Sci Rep 2024; 14:3170. [PMID: 38326383 PMCID: PMC10850091 DOI: 10.1038/s41598-024-53384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
The alkaline phosphatase-to-albumin ratio (APAR) is correlated to worse prognosis in coronary artery disease, cancer, and acute renal failure. However, the relationship between APAR and sepsis prognosis has received little research. The content of this research was to investigate the prognostic relationship between APAR and sepsis. And validate the stability of the correlation in 90-days and 1-year mortality. Retrospective cohort research was conducted basing MIMIC-IV database (version 2.0). The hazard ratio (HR) and 95% confidence interval (Cl) were computed using multivariate Cox regression analysis. In addition, plots of survival curves and subgroup analyzes were conducted. Receiver operating characteristic (ROC) curves were also used. 9741 participants were included in this investigation. The 90-days mortality was 32.8%, and the 1-year mortality was 42.0%. After controlling for confounders, the adjusted HRs (95% CI) for tertile 2 (2.2-3.8) and tertile 3 (> 3.8) were 1.37 (1.25-1.51) and 1.74 (1.58-1.91), respectively. The Kaplan-Meier curve analysis showed a higher probability of 90-days death in the higher APAR group. The area under the curve (AUC) of APAR was 0.674 and could reach 0.709 after combining the Oxford Acute Severity of Illness Score (OASIS). This study demonstrates that APAR is significantly related to bad clinical outcomes in sepsis.
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Affiliation(s)
- Shuyue Liu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Kai Zhao
- Information Network Management Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Chunhong Shao
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Lulu Xu
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Xianglun Cui
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Yong Wang
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China.
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Xue X, Li JX, Wang JW, Lin LM, Cheng H, Deng DF, Xu WC, Zhao Y, Zou XR, Yuan J, Zhang LX, Zhao MH, Wang XQ. Association between alkaline phosphatase/albumin ratio and the prognosis in patients with chronic kidney disease stages 1-4: results from a C-STRIDE prospective cohort study. Front Med (Lausanne) 2023; 10:1215318. [PMID: 37799589 PMCID: PMC10548241 DOI: 10.3389/fmed.2023.1215318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/11/2023] [Indexed: 10/07/2023] Open
Abstract
Background The alkaline phosphatase-to-albumin ratio (APAR) has been demonstrated to be a promising non-invasive biomarker for predicting prognosis in certain diseases. However, the relationship between APAR and prognosis in non-dialysis chronic kidney disease (CKD) patients remains unclear. This study aims to identify the association between APAR and prognosis among CKD stages 1-4 in China. Methods Patients with CKD stages 1-4 were consecutively recruited from 39 clinical centers in China from 2011 to 2016. New occurrences of end-stage kidney disease (ESKD), major adverse cardiovascular and cerebrovascular events, and all-cause deaths were the outcome events of this study. Subdistribution hazard competing risk and Cox proportional hazards regression models were adopted. Results A total of 2,180 participants with baseline APAR values were included in the analysis. In the primary adjusted analyses, higher APAR level [per 1-standard deviation (SD) increase in natural logarithm transformed (ln-transformed) APAR] was associated with 33.5% higher risk for all-cause deaths [adjusted hazard ratio (HR) 1.335, 95% confidence interval (CI) 1.068-1.670]. In addition, there was evidence for effect modification of the association between APAR and ESKD by baseline estimated glomerular filtration rate (eGFR) (P interaction < 0.001). A higher APAR level (per 1-SD increase in ln-transformed APAR) was associated with a greater risk of ESKD among participants with eGFR ≥ 60 ml/min/1.73 m2 (adjusted SHR 1.880, 95% CI 1.260-2.810) but not in eGFR < 60 ml/min/1.73 m2. Conclusion Higher APAR levels in patients with CKD stages 1-4 seemed to be associated with an increased risk of all-cause death. Thus, APAR appears to be used in risk assessment for all-cause death among patients with CKD stages 1-4.
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Affiliation(s)
- Xue Xue
- The First Clinical Medical School, Hubei University of Chinese Medicine, Wuhan, China
| | - Jia-Xuan Li
- School of Clinical Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, China
| | - Jin-Wei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - La-Mei Lin
- Department of Nephrology, Affiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Hong Cheng
- Department of Nephrology, Affiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Dan-Fang Deng
- Department of Nephrology, Affiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Wen-Cheng Xu
- Department of Nephrology, Affiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Yu Zhao
- Department of Nephrology, Affiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Xin-Rong Zou
- Department of Nephrology, Affiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Jun Yuan
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Lu-Xia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- National Institute of Health Data Science at Peking University, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Qin Wang
- Department of Nephrology, Affiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Hubei Key Laboratory of Theory and Application Research of Liver and Kidney in Traditional Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
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