Association of AST/ALT ratio with 90-day outcomes in patients with acute exacerbation of chronic liver disease: a prospective multicenter cohort study in China

Nonlinear association between AST/ALT ratio and 28-day all-cause mortality following ICU admission in critically ill cirrhotic patients: a retrospective cohort study

BACKGROUND

The AST/ALT ratio is a biochemical marker associated with poor clinical outcomes in various patients, but its role in severe cirrhosis is unclear. This study investigated the relationship between the AST/ALT ratio and mortality in the intensive care unit (ICU) patients with cirrhosis.

METHODS

This retrospective cohort study analyzed 2,090 liver cirrhosis patients from the MIMIC-IV database, focusing on their first ICU admission between 2008 and 2019. The AST/ALT ratio, measured within 24 h of admission, was the exposure variable, and the main outcome was 28-day mortality. A multivariable logistic regression model evaluated the link between the AST/ALT ratio and mortality. Nonlinear relationships were explored using smooth curve fitting and saturation effect analyses. Stratified analyses and interaction tests were also performed based on demographic and clinical characteristics.

RESULTS

The study involved 2,090 critically ill liver cirrhosis patients, averaging 59.1 years old, with 65% male and a 28-day post-ICU admission mortality rate of 29%. The AST/ALT ratio was linked to mortality risk (adjusted odds ratio (OR) 1.1, 95% confidence interval (CI) 1.0-1.2; p = 0.015), showing a nonlinear pattern with a critical point at 3.6. Below this, each unit increase raised mortality risk by 40% (adjusted OR 1.4, 95% CI 1.2-1.6, p < 0.001), but the effect plateaued beyond this level (adjusted OR 1.0, 95% CI 0.8-1.1, p = 0.600). Subgroup analyses confirmed the consistent association, with interaction P values over 0.05.

CONCLUSIONS

The AST/ALT ratio is an independent predictor of 28-day mortality in critically ill cirrhotic patients, with a nonlinear relationship (risk increases up to a ratio of ~ 3.6, then plateaus). This marker could enhance ICU risk stratification and inform clinical decision-making.

Associations Between Aromatic Compounds and Hepatorenal Biomarkers Among Coking Workers: Insights from Mediation Analysis

Coking activities produce high concentrations of aromatic compounds (ACs) and related substances, which may have impacts on human health. However, the health effects of these substances on humans exposed to coking sites have not been fully elucidated. A total of 637 people were recruited to participate in this cross-sectional study. Using multiple linear regression and Bayesian kernel machine regression, we investigated the relationships between the urinary parent or metabolite forms of ACs (including metabolites of PAHs and their derivatives, nitrophenols, and chlorophenols) and hepatorenal biomarkers (HRBs), including total bilirubin, aspartate aminotransferase/alanine aminotransferase, serum uric acid, creatinine, albumin/globulin, and urea. The HRBs adopted in this study can effectively represent the status of human liver and kidney function. Mediation analysis was performed to investigate the possible mediating relationship between ACs and HRBs using oxidative stress markers as mediators. Our study indicated that ACs were significantly associated with increases in TBIL, AST/ALT, A/G, and UA, as well as a significant decrease in Cr. UREA showed no association with ACs among coking workers. The oxidative stress markers 8-hydroxy-2'-deoxyguanosine, 8-iso-prostaglandin-F2α, and 8-iso,15(R)-prostaglandinF2α mediated the induction of ACs on TBIL. Our results suggest that AC exposure in coking workers may be associated with adverse changes in hepatorenal biomarkers. This study highlights the significant impact of ACs from coking activities on workers' hepatorenal biomarkers, providing crucial evidence for health risk assessment and prevention in affected populations.

Association between cardiovascular health and markers of liver function: a cross-sectional study from NHANES 2005-2018

Background

Cardiovascular health (CVH) has been associated with various systemic diseases. However, the relationship between CVH, as measured by Life's Essential 8 (LE8), and liver function markers in the general population remains poorly understood.

Methods

This study analyzed data from 21,156 participants (aged ≥ 20) from the NHANES 2005-2018 to investigate the associations between CVH and liver function markers [alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin and AST/ALT ratio]. Linear regression models were used, along with a restricted cubic spline (RCS) to assess dose-response. Weighted quantile sum (WQS) regression and quantile g-computation (QGC) analyses were employed to evaluate the association between CVH and liver function markers.

Results

Linear regression analysis showed that each 1-point increase in CVH score was significantly associated with decreased levels of liver enzymes [ALT: -0.200 U/L (95% CI: -0.223, -0.176), AST: -0.043 U/L (-0.062, -0.024), GGT: -0.453 U/L (-0.509, -0.397), ALP: -0.310 U/L (-0.340, -0.281)] and increased levels of albumin [0.040 g/dL (0.036, 0.045)] and AST/ALT ratio [0.0056 (0.0051, 0.0061)]. Notably, CVH score demonstrated non-linear dose-response relationships with ALT, ALP, and AST/ALT ratio. Age significantly modified these associations, while nicotine exposure, BMI, and blood lipids were identified as primary contributors through WQS and QGC analyses. E-value analysis suggested robustness to unmeasured confounding.

Conclusion

This study demonstrates robust associations between CVH and liver function markers in United States adults, with nicotine exposure, BMI, and blood lipids identified as significant contributors. These findings suggest that maintaining optimal cardiovascular health may have beneficial effects on liver function, highlighting potential targets for integrated prevention strategies.

Biochemical targets of chick embryos affected by sub-lethal concentrations of lambda-cyhalothrin and imidacloprid

The insecticides Lambda-cyhalothrin (LCT) and imidacloprid (IMD) are extensively utilized in Egyptian agriculture. Embryonic chicken is a readily accessible model organism commonly employed in various studies. Eggs of (Gallus Gallus) chicken were immersed in an aqueous solution of two sub-lethal concentrations (0.375 and 0.0375 mg/L for LCT; 0.05 and 0.005 mg/L for IMD) for 30  sec on the fourth day of incubation of chick embryos. Significant reductions of acetylcholinesterase (AChE) activity of brain 18- and 21-day chicks were observed in the groups treated with LCT and IMD dependent on concentrations. There were significant changes (reduction or enhancement) in serum activity of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) by LCT and IMD at the used concentrations, while non-significant stimulation in the AST/ALT ratio (AAR) was found. In 18th - day embryos, the activities of glutathione S-transferase (GST) and acid phosphatase (ACP) were not significantly changed by LCT but were significantly increased by IMD. Liver alkaline phosphatase (ALP) activity showed no significant change except IMD at 0.05 mg/L. However, serum enzyme activity was significantly reduced in all groups. In addition, the tested insecticides caused notable increases in the creatinine and total protein content. The protein profile; proteins separation with sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) showed an increase in four bands that are consistent with the results of the biomarkers level. Findings indicate that even the pesticide's low concentrations are not safe and may lead to severe damage to the embryos and may lead to significant harm or developmental disruption in the embryos.

Use of Non-Invasive Biomarkers and Clinical Scores to Predict the Complications of Liver Cirrhosis: A Bicentric Experience

Background and objectives: Liver cirrhosis is a chronic, progressive condition characterized by fibrosis and architectural distortion of the liver, leading to impaired liver function and severe complications. Accurately predicting these complications is crucial to the improvement of patient outcomes. Therefore, this study aimed to evaluate the accuracy of various non-invasive biomarkers and clinical scores in assessing the risk of complications among cirrhotic patients. Materials and methods: We conducted an observational retrospective study involving 236 cirrhotic patients from two tertiary care hospitals in Italy and Romania, in a timespan ranging from January 2021 to March 2024. Data on clinical characteristics, liver function tests, hematological indices, various non-invasive biomarkers, and clinical scores were collected and analyzed. Receiver operating characteristic analysis was performed to assess the accuracy of these biomarkers and clinical scores in predicting complications, including the presence of varices and hepato-renal syndrome. Results: The Child-Pugh score showed the highest accuracy for cirrhosis-related complications, with an area under curve (AUC) = 0.667. The red cell distribution width coefficient of variation followed closely with an AUC = 0.646. While the Child-Pugh score had a high specificity (85.42%), its sensitivity was low (37.97%). In patients with varices, non-invasive scores such as platelet distribution width (PDW) and the RDW-to-platelet ratio (RPR) showed modest predictive ability, with an AUC = 0.594. For hepato-renal syndrome, the Model for End-Stage Liver Disease (MELD) score showed the highest diagnostic accuracy with an AUC = 0.758. Conclusions: The most reliable biomarkers for detecting complications, varices, and hepato-renal syndrome, are, respectively, the Child-Pugh Score, PDW along with RPR, and the MELD score. However, while these scores remain valuable, the moderate diagnostic accuracy of other indices suggests the need for a more integrated approach to risk stratification. Future research should focus on validating these tools across different populations and incorporating emerging biomarkers to enhance predictive accuracy and inform more effective clinical decision-making.