What question did this study set out to answer?

The study aims to evaluate how well the antithrombin/creatinine ratio predicts outcomes in critically ill patients compared to traditional SOFA scores.

January 10, 2026Cureus0 citationsOpen Access

Evaluation of the Prognostic Ability of the Antithrombin/Creatinine Ratio in Critically Ill Patients: Comparison With Sequential Organ Failure Assessment (SOFA) Score and Novel Antithrombin-modified SOFA Score

KYKenya YarimizuYamagata University Hospital RYRyuto YokoyamaYamagata University Hospital HTHiroaki ToyamaYamagata University

Key Points

The study aims to evaluate how well the antithrombin/creatinine ratio predicts outcomes in critically ill patients compared to traditional SOFA scores.
Conducted a comparative analysis of antithrombin/creatinine ratio and SOFA scores in critically ill patients.

Structured PICO

Does the antithrombin/creatinine (AT/Cre) ratio predict hospital discharge mortality in critically ill patients?

Population

267 critically ill patients admitted to participating hospital ICUs between January 2018 and December 2019 with antithrombin (AT) activity measurement within 24 hours of ICU admission, median age 69, 64.8% male. Key exclusions: mortality within 24 hours of ICU admission, age below 18 years, AT preparation use before measurement, pregnancy, congenital AT deficiency, and HIV infection or acquired immunodeficiency syndrome.

Intervention

Antithrombin/creatinine (AT/Cre) ratio and novel Antithrombin-modified SOFA (ASOFA) score

Comparator

Sequential Organ Failure Assessment (SOFA) score, APACHE II score, and acute DIC score

Outcome

Hospital discharge mortalityhard clinical

The antithrombin/creatinine ratio is a simple, easily calculated biomarker that provides prognostic discrimination for in-hospital mortality comparable to the complex SOFA score in critically ill patients.

Abstract

PURPOSE: The objective of the study was to evaluate the prognostic ability of the antithrombin/creatinine (AT/Cre) ratio in critically ill patients and compare it with the Sequential Organ Failure Assessment Score (SOFA) score. METHODS: This retrospective cohort study was conducted at two hospitals and included patients admitted to the ICUs between January 2018 and December 2019 who had their AT activity measured within 24 hours of ICU admission. The primary endpoint was mortality at discharge. Statistical analyses included receiver operating characteristic (ROC) curve analysis, K-means clustering, and the Cox proportional hazards model. RESULTS: The study included 267 patients, of whom 173 (64.8%) were male. The median age was 69 years. The AT/Cre ratio demonstrated prognostic accuracy of mortality at discharge (AUC: 0.71, cut-off: 53.6) comparable to the SOFA score (AUC: 0.75, cut-off: 8.0). A lower AT/Cre ratio was significantly associated with increased mortality risk in multivariate analyses (hazard ratio (HR): 0.98, 95%CI: 0.98-0.99). When patients were categorized into four clusters, AT/Cre values differed significantly between clusters (p <0.0001), with higher values in clusters with a favorable prognosis. CONCLUSION: The AT/Cre ratio showed prognostic performance comparable to SOFA, although its incremental value beyond established scores was not evaluated in this study. It is simple to calculate and may be valuable for early risk stratification and treatment decisions.

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