Does Aspartate Aminotransferase to Alanine Aminotransferase Ratio Predict Acute Kidney Injury After Cardiac Surgery?

Abstract

Background: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) frequently is used in the diagnosis and prognosis of liver diseases, however it is also used in the diagnosis and prognosis of many other diseases, such as myocardial infarction, acute ischemic stroke, and peripheral artery disease. Acute kidney injury (AKI) is one of the most important complications after cardiac surgery and is one of the main causes of morbidity and mortality. The purpose of the study was to analyze the relationship between AST to ALT and AKI after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 253 adult patients, who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL). Preoperative (T0) and postoperative day 1 and day 3 (T1 and T2) serum AST and ALT levels were analyzed, and AST/ALT was calculated. A preoperative AST/ALT of 1.22 was found to be the best cutoff point for predicting postoperative AKI. Kidney injury was interpreted, according to RIFLE classification. The effect of AST to ALT ratio on AKI after CABG was determined using logistic regression analysis, and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. Results: Postoperative AKI occurred in 40 patients (15.8%). On logistic regression analysis, higher AST/ALT both preoperatively and postoperatively were associated with an increased incidence of postoperative AKI (T0: OR, 3.983; 95% CI, 1.940-8.180, P < .001, T1: OR, 2.760; 95% CI, 1.381-5.515, P = .004, T2: OR, 2.515; 95% CI, 1.195-5.294, P = .015). Conclusion: Preoperative and postoperative elevated AST to ALT ratio seems to be associated with an increased incidence of AKI after elective isolated CABG surgery.

Postoperative Alanine Aminotransferase Levels Are Associated with Outcomes in Pediatric Patients Undergoing Total Cavopulmonary Connection

“…The AST/ALT ratio predicts overall survival after surgery in gastric cancer patients [ 22 ]. Increased ratios of AST/ALT both preoperatively and postoperatively were associated with an increased incidence of postoperative acute renal injury after cardiac surgery [ 23 ]. However, previous studies did not demonstrate associations between postoperative ALT levels and outcomes in pediatric patients undergoing TCPC.…”

Preoperative Liver Function Test Abnormalities Were Associated With Short-Term and Long-Term Prognosis in Cardiac Surgery Patients Without Liver Disease

“…Alanine transaminase and AST are classic cytoplasmic enzymes and inflammation-associated components that can be immediately released into the bloodstream following the deleterious effect of heart failure on the liver ( 19 , 20 ). For patients with heart failure, there is a graded relationship between admission transaminase levels and surrogate indicators of in-hospital mortality ( 21 ).…”

“…Furthermore, more significant ALT elevation can be used as an independent predictor of hospital mortality, deterioration of renal function, ICU admission, and longer time of hospital stay ( 21 ). Preoperative and postoperative AST/ALT might be an independent predictor of AKI after cardiac surgery ( 20 ). Our research is consistent with previous reports.…”

Cytokines in Abdominal Aortic Aneurysm: Master Regulators With Clinical Application

“…A possible solution is a search of appropriate integrative indicators and coefficients based on the ratio of various cytokines’ levels in AAA. This approach is already successfully applied in clinical practice when analyzing numerous biochemical parameters, namely the fibrinogen-to-albumin ratio as a new clinical marker of microinflammation 142 ; the CRP/albumin ratio as an independent prognostic marker in different types of cancer, 143 and as a scoring system for determining the stage and activity of an inflammatory disease 142 ; the De Ritis (AST/ALT) ratio for the diagnosis and prognosis making in liver diseases, myocardial infarction, acute ischemic stroke, peripheral artery disease, and kidney injury 144 ;the blood urea nitrogen-to-creatinine ratio as an independent prognostic indicator of poor outcomes in various diseases, such as heart failure, kidney injury, and stroke 145 ; finally, the atherogenic index of plasma (a logarithm of the ratio between plasma triglyceride and high density lipoprotein cholesterol levels) as a sensitive marker of the risk to develop atherosclerosis and cardiovascular disease. 146 Identifying highly sensitive and specific relations between cytokines in the context of AAA seems to be an appropriate approach to create various test systems and diagnostic panels.…”