Potential Clinical Value of Pretreatment De Ritis Ratio as a Prognostic Biomarker for Renal Cell Carcinoma

Li, Jinze; Cao, Deliang; Peng, Lei; Meng, Chunyang; Xia, Zhongyou; Li, Yunxiang; Wang, Qiang

doi:10.3389/fonc.2021.780906

Cited by 7 publications

(9 citation statements)

References 41 publications

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“…The current literature investigating the prognostic utility of De Ritis ratio for RCC has produced conflicting findings (7,27), and in our study utilizing a threshold of 2.72, we found De Ritis ratio was significantly associated with all studied outcomes. A meta-analysis by Li et al of 6,528 patients from 11 studies reported a significant association of high pretreatment De Ritis ratio with worse OS (HR 1.41, p<0.001) and CSS (HR 1.59, p<0.001) in patients with renal cell carcinoma (28). The metaanalysis, however, included three studies of patient cohorts treated non-surgically with tyrosine kinase inhibitors or targeted therapy.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis by Li et al. of 6,528 patients from 11 studies reported a significant association of high pretreatment De Ritis ratio with worse OS (HR 1.41, p<0.001) and CSS (HR 1.59, p<0.001) in patients with renal cell carcinoma ( 28 ). The meta-analysis, however, included three studies of patient cohorts treated non-surgically with tyrosine kinase inhibitors or targeted therapy.…”

Section: Discussionmentioning

confidence: 99%

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Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and De Ritis ratio with mortality in renal cell carcinoma: A multicenter analysis

et al. 2022

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BackgroundSeveral markers of inflammation have been associated with oncologic outcomes. Prognostic markers are not well-defined for renal cell carcinoma (RCC). We sought to investigate the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis ratio with mortality in RCC.MethodsMulti-center retrospective analysis of patients undergoing surgery for RCC. Primary outcome of interest was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM) and cancer-specific mortality (CSM). Elevated NLR was defined as ≥2.27, elevated PLR as ≥165, and elevated De Ritis ratio as ≥ 2.72. Multivariable cox regression analysis (MVA) was conducted to elucidate risk factors for primary and secondary outcomes, and Kaplan-Meier analysis (KMA) was used to evaluate survival outcomes comparing elevated and non-elevated NLR, PLR, and De Ritis ratio.Results2656 patients were analyzed (874 patients had elevated NLR; 480 patients had elevated PLR and 932 patients had elevated De Ritis). Elevated NLR was a significant predictor of ACM (HR 1.32, 95% CI: 1.07-1.64, p=0.003) and NCM (HR 1.79, 95% CI: 1.30-2.46, p<0.001) in MVA. Elevated De Ritis was a significant predictor of ACM (HR 2.04, 95% CI: 1.65-2.52), NCM (HR 1.84, 95% CI: 1.33-2.55, p<0.001), and CSM (HR 1.97, 95% CI:1.48-2.63, p<0.001). KMA revealed significant difference in 5-year overall survival (OS) (48% vs. 68%, p<0.001), non-cancer survival (NCS) (69% vs. 87%, p<0.001), and cancer-specific survival (CSS) (60% vs. 73%, p<0.001) for elevated versus non-elevated NLR. For PLR, there was a difference in 5-year OS (51% vs. 61%, p<0.001) and CSS (60% vs. 73%, p<0.001) with KMA.ConclusionsElevated NLR was independently associated with worse ACM and NCM, while elevated De Ritis was predictive for CSM in addition to ACM and NCM. These differences may be useful in refining risk stratification with respect to cancer-related and non-cancer mortality in RCC patients and deserve further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and De Ritis ratio with mortality in renal cell carcinoma: A multicenter analysis

et al. 2022

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“…Because the AST level is associated with other organs affected systemically and ALT level specifically indicates parenchymal liver disease, changes in these two enzymes may be useful for the diagnosis or risk stratification of various illnesses [ 9 ]. Serum ratio of AST/ALT, the so-called “De Ritis ratio (DRR)”, has been reported to be a valuable marker in differentiating varying causes of liver disease [ 9 , 13 , 14 ], surrogating different kinds of malignancies [ 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ], and provides valuable information on the risk assessment of patients with heart diseases [ 22 , 23 , 24 ], acute kidney injury [ 25 , 26 , 27 ], sepsis [ 28 ], and even patients with COVID-19 [ 29 , 30 , 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Delta De Ritis Ratio Is Associated with Worse Mortality Outcomes in Adult Trauma Patients with Moderate-to-Severe Traumatic Brain Injuries

et al. 2022

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This study aimed to investigate whether changes in the De Ritis ratio (DRR) can be used to stratify the mortality risk of patients with moderate-to-severe traumatic brain injury (TBI). This retrospective study reviewed data for 1347 adult trauma patients (134 deaths and 1213 survival) with moderate-to-severe TBI between 1 January 2009, and 31 December 2020, from the registered trauma database. The outcomes of the patients allocated into the two study groups were compared based on the best Delta DRR (ΔDRR) cutoff point. The first and second DRR of patients who died were significantly higher than those of patients who survived. Elevation of DRR 72–96 h later was found for patients who died, but not for those who survived; the ΔDRR of the patients who died was significantly higher than that of those who survived (1.4 ± 5.8 vs. −0.1 ± 3.3, p = 0.004). Multivariate logistic regression analysis revealed that ΔDRR was a significant independent risk factor for mortality in these patients. Additionally, a ΔDRR of 0.7 was identified as the cutoff value for mortality stratification of adult trauma patients at high risk of mortality with moderate-to-severe TBI.

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“…Ischemia-reperfusion injury, oxidative stress, and metabolic disorders can increase serum levels of AST [ 4 , 5 , 6 ]. Therefore, DRR has also been proposed to be valuable in the diagnosis and risk stratification of many illnesses other than liver diseases, including cancers other than hepatoma [ 1 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ], acute kidney injury [ 14 , 15 , 16 ], heart diseases [ 17 , 18 , 19 ], sepsis [ 20 ], and coronavirus disease 2019 (COVID-19) [ 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Using Second Measurement of De Ritis Ratio to Improve Mortality Prediction in Adult Trauma Patients in Intensive Care Unit

Rau

Chou

et al. 2022

Diagnostics

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The De Ritis ratio (DRR), the ratio of serum levels of aspartate aminotransferase/alanine aminotransferase, has been reported to be a valuable biomarker in risk stratification for many liver and non-liver diseases. This study aimed to explore whether the inclusion of DRR at the date of intensive care unit (ICU) admission or days after ICU admission improves the predictive performance of various prognosis prediction models. This study reviewed 888 adult trauma patients (74 deaths and 814 survivors) in the trauma registered database between 1 January 2009, and 31 December 2020. Medical information with AST and ALT levels and derived DRR at the date of ICU admission (1st DRR) and 3–7 day after ICU admission (2nd DRR) was retrieved. Logistic regression was used to build new probability models for mortality prediction using additional DRR variables in various mortality prediction models. There was no significant difference in the 1st DRR between the death and survival patients; however, there was a significantly higher 2nd DRR in the death patients than the survival patients. This study showed that the inclusion of the additional DRR variable, measured 3–7 days after ICU admission, significantly increased the prediction performance in all studied prognosis prediction models.

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Potential Clinical Value of Pretreatment De Ritis Ratio as a Prognostic Biomarker for Renal Cell Carcinoma

Cited by 7 publications

References 41 publications

Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and De Ritis ratio with mortality in renal cell carcinoma: A multicenter analysis

Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and De Ritis ratio with mortality in renal cell carcinoma: A multicenter analysis

Delta De Ritis Ratio Is Associated with Worse Mortality Outcomes in Adult Trauma Patients with Moderate-to-Severe Traumatic Brain Injuries

Using Second Measurement of De Ritis Ratio to Improve Mortality Prediction in Adult Trauma Patients in Intensive Care Unit

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