Value of International Normalized Ratio to Albumin Ratio in Predicting the Outcome of Cirrhotic Patients with Sepsis

Background: Sepsis is a major cause of mortality among cirrhotic patients, yet early risk stratification remains challenging. The prothrombin time–international normalized ratio to albumin ratio (PTAR) has emerged as a simple marker reflecting hepatic dysfunction. This study aimed to evaluate the value of PTAR in predicting the outcome of cirrhotic patients with sepsis during their hospital stay.Methods: A prospective cohort study was conducted on 32 patients with liver cirrhosis and sepsis. The prothrombin time–international normalized ratio to albumin ratio (PTAR), Sequential Organ Failure Assessment (SOFA) score, and Chronic Liver Failure–Sequential Organ Failure Assessment (CLIF-SOFA) score were calculated at admission and patients were followed up during their hospital stay. Results: In-hospital mortality reached 65.6%. Non-survivors had significantly higher PTAR (0.73 vs 0.50, p = 0.021), PTAR cutoff value of ≥0.545 predicted mortality with an area under the curve (AUC) of 0.751, sensitivity 81%, specificity 63.6%, and overall accuracy 75% (p = 0.021). For predicting bloodstream infection, PTAR ≥0.58 achieved an AUC of 0.86, sensitivity 80%, specificity 83.3%, and accuracy 81.3% (p < 0.001). In binary regression analysis, high PTAR, increased serum creatinine, and elevated CLIF-SOFA score were independent predictors of mortality.Conclusion: PTAR could be a reliable, simple, and cost-effective index for early prediction of mortality and bloodstream infection in cirrhotic patients with sepsis. Its strong correlation with hepatic dysfunction and organ failure severity supports its use as a practical bedside tool for outcome prediction and risk stratification in clinical practice.