Increased concentrations of serum aspartate transaminase (AST) and alanine transaminase (ALT) are common in COVID-19 patients. However, their capacity to predict mortality, particularly the AST/ALT ratio, commonly referred to as the De Ritis ratio, is unknown. We investigated the association between the De Ritis ratio on admission and in-hospital mortality in 105 consecutive patients with coronavirus disease of 2019 (COVID-19) admitted to three COVID-19 referral centres in Sardinia, Italy. The De Ritis ratio was significantly lower in survivors than nonsurvivors (median: 1.25; IQR: 0.91-1.64 vs 1.67; IQR: 1.38-1.97, P =.002) whilst there were no significant between-group differences in ALT and AST concentrations. In ROC curve analysis, the AUC value of the De Ritis ratio was 0.701 (95% CI 0.603-0.787, P =.0006) with sensitivity and specificity of 74% and 70%, respectively. Kaplan-Meier survival curves showed a significant association between the De Ritis ratio and mortality (logrank test P =.014). By contrast, no associations were observed between the ALT and AST concentrations and mortality (logrank test P =.83 and P =.62, respectively). In multivariate Cox regression analysis, the HR in patients with De Ritis ratios ≥1.63 (upper tertile of this parameter) remained significant after adjusting for age, gender, smoking status, cardiovascular disease, intensity of care, diabetes, respiratory diseases, malignancies and kidney disease (HR: 2.46, 95% CI 1.05-5.73, P =.037). Therefore, the De Ritis ratio on admission was significantly associated with in-hospital mortality in COVID-19 patients. Larger studies are required to confirm the capacity of this parameter to independently predict mortality in this group.

The De Ritis ratio as prognostic biomarker of in-hospital mortality in COVID-19 patients / Zinellu, A.; Arru, F.; De Vito, A.; Sassu, A.; Valdes, G.; Scano, V.; Zinellu, E.; Perra, R.; Madeddu, G.; Carru, C.; Pirina, P.; Mangoni, A. A.; Babudieri, S.; Fois, A. G.. - In: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION. - ISSN 0014-2972. - (2020), p. e13427. [10.1111/eci.13427]

The De Ritis ratio as prognostic biomarker of in-hospital mortality in COVID-19 patients

Zinellu A.;De Vito A.;Valdes G.;Scano V.;Zinellu E.;Madeddu G.;Carru C.;Pirina P.;Babudieri S.;Fois A. G.
2020-01-01

Abstract

Increased concentrations of serum aspartate transaminase (AST) and alanine transaminase (ALT) are common in COVID-19 patients. However, their capacity to predict mortality, particularly the AST/ALT ratio, commonly referred to as the De Ritis ratio, is unknown. We investigated the association between the De Ritis ratio on admission and in-hospital mortality in 105 consecutive patients with coronavirus disease of 2019 (COVID-19) admitted to three COVID-19 referral centres in Sardinia, Italy. The De Ritis ratio was significantly lower in survivors than nonsurvivors (median: 1.25; IQR: 0.91-1.64 vs 1.67; IQR: 1.38-1.97, P =.002) whilst there were no significant between-group differences in ALT and AST concentrations. In ROC curve analysis, the AUC value of the De Ritis ratio was 0.701 (95% CI 0.603-0.787, P =.0006) with sensitivity and specificity of 74% and 70%, respectively. Kaplan-Meier survival curves showed a significant association between the De Ritis ratio and mortality (logrank test P =.014). By contrast, no associations were observed between the ALT and AST concentrations and mortality (logrank test P =.83 and P =.62, respectively). In multivariate Cox regression analysis, the HR in patients with De Ritis ratios ≥1.63 (upper tertile of this parameter) remained significant after adjusting for age, gender, smoking status, cardiovascular disease, intensity of care, diabetes, respiratory diseases, malignancies and kidney disease (HR: 2.46, 95% CI 1.05-5.73, P =.037). Therefore, the De Ritis ratio on admission was significantly associated with in-hospital mortality in COVID-19 patients. Larger studies are required to confirm the capacity of this parameter to independently predict mortality in this group.
The De Ritis ratio as prognostic biomarker of in-hospital mortality in COVID-19 patients / Zinellu, A.; Arru, F.; De Vito, A.; Sassu, A.; Valdes, G.; Scano, V.; Zinellu, E.; Perra, R.; Madeddu, G.; Carru, C.; Pirina, P.; Mangoni, A. A.; Babudieri, S.; Fois, A. G.. - In: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION. - ISSN 0014-2972. - (2020), p. e13427. [10.1111/eci.13427]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11388/240229
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