The Elevated De Ritis Ratio on Admission Is Independently Associated with Mortality in COVID-19 Patients

Abstract

Liver damage in COVID-19 patients was documented as increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels or an elevated AST/ALT ratio, known as the De Ritis ratio. However, the prognostic value of the elevated De Ritis ratio in COVID-19 patients is still unknown. The aim of our study was to evaluate the prognostic value of the De Ritis ratio compared to other abnormal laboratory parameters and its relation to mortality. We selected 322 COVID-19 patients in this retrospective study conducted between November 2020 and March 2021. The laboratory parameters were measured on admission and followed till patient discharge or death. Of the 322 COVID-19 patients, 57 (17.7%) had gastrointestinal symptoms on admission. The multivariate analysis showed that the De Ritis ratio was an independent risk factor for mortality, with an OR of 29.967 (95% CI 5.266–170.514). In ROC analysis, the AUC value of the the De Ritis ratio was 0.85 (95% CI 0.777–0.923, p < 0.05) with sensitivity and specificity of 80.6% and 75.2%, respectively. A De Ritis ratio ≥1.218 was significantly associated with patient mortality, disease severity, higher AST and IL-6 levels, and a lower ALT level. An elevated De Ritis ratio on admission is independently associated with mortality in COVID-19 patients, indicating liver injury and cytokine release syndrome.

Effectiveness of COVID-19 Vaccination with mRNA Vaccines for Patients with Cirrhosis in Hungary: Multicentre Matched Cohort Study

“…As for the etiology of cirrhosis, alcohol-related liver cirrhosis was found to be a leading cause and patients with alcohol-use disorder are notably more susceptible to hepatic decompensation following COVID-19 infection, in line with recently published studies [ 6 , 31 , 32 ].…”

An Updated Systematic Review and Meta-Analysis of the Association between the De Ritis Ratio and Disease Severity and Mortality in Patients with COVID-19

“…Two studies had a prospective study design [45,53], whilst the remaining 22 were retrospective [30][31][32][33][34][46][47][48][49][50][51][52][54][55][56][57][58][59][60][61][62][63]. The clinical endpoints assessed included mortality (15 studies) [30][31][32][33][34][46][47][48][50][51][52][54][55][56]62] and the following measures of severe disease: clinical severity based on existing guidelines (8 studies) [33,45,49,53,[56][57][58][59], transfer to the ICU (two studies) [56,62], persistent viral positivity (one study) [6...…”

“…Of them, 4757 were either duplicates or irrelevant and, therefore, excluded. After a full review of the remaining 27 articles, three were excluded because they did not meet the inclusion criteria, leaving 24 articles for analysis (Figure 1) [30][31][32][33][34][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. Two studies had a prospective study design [45,53], whilst the remaining 22 were retrospective [30][31][32][33][34][46][47][48][49][50][51][52][54][55][56][57][58][59][60][61][62][63].…”

“…One study was conducted in Turkey [56], one in China [32], one in India [58], one in Italy [34], one in Croatia [51], and one in Hungary (Supplementary Table S7) [52]. [32,34,51,52,56,58]. Endpoints included mortality (five studies) [32,34,51,52,56] and the following measures of severe disease: clinical severity based on existing clinical guidelines (two studies) [56,58] and ICU admission (one study) [56].…”

“…[32,34,51,52,56,58]. Endpoints included mortality (five studies) [32,34,51,52,56] and the following measures of severe disease: clinical severity based on existing clinical guidelines (two studies) [56,58] and ICU admission (one study) [56]. One study was conducted in Turkey [56], one in China [32], one in India [58], one in Italy [34], one in Croatia [51], and one in Hungary (Supplementary Table S7) [52].…”