Enhancing Prognostication in Cirrhosis with Sepsis: INR to Albumin Ratio Vs Meld-Based Scoring Systems

Abstract Background: Liver cirrhosis is an important cause of morbidity and mortality globally with sepsis being a life-threatening complication in cirrhotic patients. Traditional scoring systems like Model for End-stage liver disease (MELD) are widely used to predict prognosis in cirrhotic patients. However, recent evidence suggests that Prothrombin time-international normalized ratio (PT-INR) to Albumin Ratio (PTAR score) may serve as a simple and effective alternate marker for risk stratification in patients of cirrhosis with sepsis. Methods: This prospective hospital-based observational study included 90 patients aged 18-65 years with cirrhosis and sepsis (qSOFA ≥ 2). Patients were excluded if they had bleeding disorders, were on anticoagulants, pregnant, malignancy, or other chronic illnesses. PTAR score at admission and MELD scores were calculated, and their predictive value for mortality and disease severity was assessed using statistical methods such as ROC Curve analysis. Results: The study revealed that, the MELD-Na Score demonstrated the highest predictive accuracy for mortality (AUROC = 0.90, Sensitivity = 85.00%, Specificity = 82.00%), outperforming both the MELD Score (AUROC = 0.85, Sensitivity = 76.67%, Specificity = 78.33%) and the PTAR score (AUROC = 0.82, Sensitivity = 77.78%, Specificity = 75.56%). Conclusion: The PTAR score can be easily calculated at the bedside and correlates with the prognosis, with higher scores assosciated with increased mortality. While it provides moderate prognostic value and may be valuable in resource limited settings, it does not surpass MELD-based scoring systems and may complement other scoring systems in patients of cirrhosis of liver with sepsis.