Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure

Daichi Maeda,Nobuyuki Kagiyama,Yuki Ogasahara,Tetsuya Ozawa,Kentaro Jujo,Ryusuke Yonezawa,K Iwata ,Tsutomu Sunayama,Shuhei Yamamoto,Masaaki Konishi,Taishi Dotare,Hiroshi Wada,Katsuya Izawa,Kazuya Saito,Hirofumi Nagamatsu,Takatoshi Kasai,Kentaro Kamiya,Kazuhiro Oka,Takeshi Kitai,Shin‐Ichi Momomura ,Hiroshi Saitô ,Masaru Hiki,Emi Maekawa,Naoki Aizawa,Yuya Matsue

doi:10.1038/s41598-021-91368-z

Abstract

Frailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management. We hypothesized that the AST to ALT ratio (AAR) could be a marker of frailty in patients with heart failure. Data from the FRAGILE-HF study were analyzed. A total of 1327 patients aged ≥ 65 years hospitalized with heart failure were categorized into three groups based on their AAR at discharge: low AAR (AAR < 1.16, n = 434); middle AAR (1.16 ≤ AAR < 1.70, n = 487); high AAR (AAR ≥ 1.70, n = 406). The primary endpoint was one-year mortality. The association between AAR and physical function was also assessed. High AAR was associated with lower short physical performance battery and shorter 6-min walk distance, and these associations were independent of age and sex. Logistic regression analysis revealed that high AAR was an independent marker of physical frailty after adjustment for age, sex and body mass index. During follow-up, all-cause death occurred in 161 patients. After adjusting for confounding factors, high AAR was associated with all-cause death (low AAR vs. high AAR, hazard ratio: 1.57, 95% confidence interval, 1.02–2.42; P = 0.040). In conclusion, AAR is a marker of frailty and prognostic for all-cause mortality in older patients with heart failure.

Highlights

Frailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management
Patients with high AST to ALT ratio (AAR) were older in age, more of females, and had New York Heart Association class III/IV, prior history of heart failure and use of loop diuretics, lower body mass index, and higher left ventricular ejection fraction
Laboratory data showed that patients with high AAR had higher brain natriuretic peptide (BNP) and lower albumin, AST, ALT, estimated glomerular filtration rate, and hemoglobin levels

Summary

Introduction

Frailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management. Logistic regression analysis revealed that high AAR was an independent marker of physical frailty after adjustment for age, sex and body mass index. AAR is a marker of frailty and prognostic for all-cause mortality in older patients with heart failure. We previously demonstrated a significant association between high aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) and low body mass index, malnutrition, and worse outcomes in patients with acute heart failure[5], suggesting high AAR as a marker of frailty status in patients with heart failure. The direct association between AAR and physical frailty or exercise capacity has not been evaluated in older patients with heart failure. We aimed to evaluate the association between AAR and physical frailty, exercise capacity, and prognosis in older patients with heart failure

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