Clinical value of albumin-corrected anion gap combined with lactate dehydrogenase in predicting sepsis-associated liver injury in children: a single-center retrospective cohort study

The purpose of this study was to examine the predictive value of albumin-corrected anion gap (ACAG) for the early detection of pediatric sepsis-associated liver injury (SAIL). A retrospective analysis was performed on clinical data of pediatric patients with sepsis who were admitted to the Pediatric Intensive Care Unit (PICU) at Anhui Provincial Children's Hospital between January 2021 and February 2024. Patients were divided into two groups based on the presence of liver injury: 118 cases in the non-liver injury group and 30 cases in the liver injury group. Logistic regression analysis was performed to identify risk factors for SAIL in children. The predictive value of each independent risk factor for the early diagnosis of SAIL was evaluated using receiver operating characteristic (ROC) curves. In a group of 148 pediatric patients diagnosed with sepsis, 30 individuals, representing 20.27%, developed SAIL. The SAIL group exhibited a significantly higher mortality rate than the non-SAIL group (P<0.05), with patients having abdominal infections as the primary infection site being more susceptible to SAIL. Significant differences were observed between the SAIL and non-SAIL groups in terms of albumin (ALB), platelet (PLT) count, ACAG, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), serum creatinine (SCr), blood urea nitrogen (BUN), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), international normalized ratio (INR), fibrinogen concentration (FDP), prothrombin time (PT), thrombin time(TT), activated partial thromboplastin time (APTT), and D-dimer levels (P<0.05). No significant differences were found between the two groups regarding age, sex, birth status, white blood cell count and alkaline phosphatase (ALP), Cholinesterase(CHE) (P>0.05).Multivariate logistic regression analysis identified ACAG (OR = 1.017, 95% CI: 1.016–1.207, P = 0.021), LDH (OR = 1.037, 95% CI: 1.009–1.066, P = 0.009), intra-abdominal infection (OR = 5.450, 95% CI: 1.190–24.958, P = 0.029), and severe lactic acidosis (OR = 2.585, 95% CI: 1.129–5.922, P = 0.025) as independent risk factors for SAIL. Receiver operating characteristic (ROC) curve analysis showed that the combination of ACAG and LDH yielded an area under the curve (AUC) of 0.906 (95% CI: 0.843–0.962) for predicting SAIL. At a cutoff value of 21.88, the sensitivity was 90.00% and the specificity was 82.20%. ACAG, LDH, severe lactic acidosis, and abdominal infection were identified as independent predictors of sepsis-associated liver injury (SAIL) incidence in children, the combination of ACAG and LDH had a better predictive value than individual indicators.