De Ritis Ratio Research Articles

Association of preoperative serum De Ritis ratio with oncological outcomes in patients treated with cytoreductive nephrectomy for metastatic renal cell carcinoma

PurposeIdentifying which patients are likely to benefit from cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) is important. We tested the association between preoperative serum De Ritis ratio (DRR, Aspartate Aminotransferase/Alanine Aminotransferase) and overall survival (OS) as well as cancer-specific survival (CSS) in mRCC patients treated with CN. Material and methodsmRCC patients treated with CN at different institutions were included. After assessing for the optimal pretreatment DRR cut‐off value, we found 1.2 to have the maximum Youden index value. The overall population was therefore divided into 2 DRR groups using this cut‐off (low, <1.2 vs. high, ≥1.2). Univariable and multivariable Cox regression analyses tested the association between DRR and OS as well as CSS. The discrimination of the model was evaluated with the Harrel's concordance index (C-index). The clinical value of the DRR was evaluated with decision curve analysis. ResultsAmong 613 mRCC patients, 239 (39%) patients had a DRR ≥1.2. Median follow-up was 31 (IQR 16–58) months. On univariable analysis, high DRR was significantly associated with OS (hazard ratios [HR]: 1.22, 95% confidence interval [CI]: 1.01–1.46, P = 0.04) and CSS (HR: 1.23, 95% CI: 1.02–1.47, P = 0.03). On multivariable analysis, which adjusted for the effect of established clinicopathologic features, high DRR remained significantly associated with both OS (HR: 1.26, 95% CI: 1.04-1.52, P = 0.02) and CSS (HR: 1.26, 95% CI: 1.05–1.53, P = 0.01). The addition of DRR only minimally improved the discrimination of a base model that included established clinicopathologic features (C-index = 0.633 vs. C-index = 0.629). On decision curve analysis, the inclusion of DRR did not improve the net-benefit beyond that obtained by established subgroup analyses stratified by IMDC risk groups, type of systemic therapy, body mass index and sarcomatoid features, did not reveal any prognostic value to DRR. ConclusionDespite the statistically significant association between DRR and OS as well as CSS in mRCC patients treated with CN, DRR does not seem to add any further prognostic value beyond that obtained by currently available features.

Association of Preoperative De Ritis Ratio (Aspartate Amino Transferase/Alanine Amino Transferase) and Tumour Histology in Patients with Primary Bladder Cancer

Association of Preoperative De Ritis Ratio (Aspartate Amino Transferase/Alanine Amino Transferase) and Tumour Histology in Patients with Primary Bladder Cancer

The Importance of De Ritis Ratio in Patients with Bladder Cancer

The Importance of De Ritis Ratio in Patients with Bladder Cancer

Association of De Ritis ratio with oncological outcomes in patients with non-muscle invasive bladder cancer (NMIBC)

PurposeThe De Ritis ratio (aspartate aminotransferase/alanine aminotransferase, DRR) has been linked to oncological outcomes in several cancers. We aimed to assess the association of DRR with recurrence-free survival (RFS) and progression-free survival (PFS) in patients with non-muscle-invasive bladder cancer (NMIBC).MethodsWe conducted a retrospective analysis of 1117 patients diagnosed with NMIBC originating from an established multicenter database. To define the optimal pretreatment DRR cut‐off value, we determined a value of 1.2 as having a maximum Youden index value. The overall population was therefore divided into two De Ritis ratio groups using this cut‐off (lower, < 1.2 vs. higher, ≥ 1.2). Univariable and multivariable Cox regression analyses were used to investigate the association of DRR with RFS and PFS. The discrimination of the model was evaluated with the Harrel’s concordance index (C-index).ResultsOverall, 405 (36%) patients had a DRR ≥ 1.2. On univariable Cox regression analysis, DRR was significantly associated with RFS (HR: 1.23, 95% CI 1.02–1.47, p = 0.03), but not with PFS (HR: 0.96, 95% CI 0.65–1.44, p = 0.9). On multivariable Cox regression analysis, which adjusted for the effect of established clinicopathologic features, DRR ≥ 1.2 remained significantly associated with worse RFS (HR:1.21, 95% CI 1.00–1.46, p = 0.04). The addition of DRR only minimally improved the discrimination of a base model that included established clinicopathologic features (C-index = 0.683 vs. C-index = 0.681). On DCA the inclusion of DRR did not improve the net-benefit of the prognostic model.ConclusionDespite the statistically significant association of the DRR with RFS in patients with NMIBC, it does not seem to add any prognostic or clinical benefit beyond that of currently available clinical factors.

Laboratory test alterations in patients with COVID-19 and non COVID-19 interstitial pneumonia: a preliminary report.

Coronavirus disease 19 (COVID-19) is the greatest pandemic in modern history. Laboratory test alterations have been described in COVID-19 patients, but differences with other pneumonias have been poorly investigated to date, especially in Caucasian populations. The aim of this study was to investigate differences and prognostic potential of routine blood tests in a series of Italian patients with COVID-19 and non-COVID-19 interstitial pneumonia. Clinical data and routine laboratory tests of a consecutive series of 30 COVID-19 patients and 30 age and sex matched patients with non COVID-19 interstitial pneumonia have been retrospectively collected. Differences in laboratory tests between patients with COVID-19 and non COVID-19 pneumonias have been investigated, as well as differences between COVID-19 survivors and non survivors. COVID-19 patients had lower white blood cells, monocytes, neutrophils, and higher platelet counts. In addition, COVID-19 patients showed higher mean platelet volume, lower C reactive protein concentrations, and higher De Ritis ratio. Combined blood cell indexes of systemic inflammation were significantly lower in COVID-19 patients. In further analysis of the COVID-19 group, the neutrophil count, neutrophil to lymphocyte ratio (NLR), derived NLR, systemic inflammation response index and De Ritis ratio, were significantly higher in non survivors than in survivors, while the number of platelets was significantly lower in non survivors. Our study showed several alterations in blood cell populations and indexes in patients with COVID-19 pneumonia in comparison with patients with non COVID-19 pneumonia. Some of these indexes showed promising prognostic abilities. Further studies are necessary to confirm these results.

De Ritis ratio and biochemical parameters in COVID-19 patients

Background The study aimed to examine some biochemical test parameters and De Ritis ratio in COVID-19 patients, considering age and gender. Method The study was performed on patients with real-time polymerase chain reaction and computed tomography lung diagnosis. The relationship between lactate dehydrogenase, creatine kinase (CK), creatine kinase-MB, alanine aminotransferase, aspartate aminotransferase and De Ritis ratio were analysed in the first blood samples of the patients. The difference between gender was also compared with the independent sample t-test. Alpha value was accepted <0.05. Results The De Ritis was significantly higher in females (p = .040). The De Ritis ratio was associated with CK in both gender. There was no significant difference in the biochemical parameters according to gender. Conclusion The De Ritis ratio appears to be a parameter that can be used in COVID-19 patients. However, more detailed and comprehensive studies including the symptoms of patients are needed.

Clinical Significance of Pre-to-Postoperative Dynamics of Aspartate Transaminase/Alanine Transaminase Ratio in Predicting the Prognosis of Renal Cell Carcinoma after Surgical Treatment.

Background This study is aimed at examining the prognostic role of pre-to-postoperative dynamics of De Ritis ratio (aspartate aminotransaminase (AST)/alanine aminotransaminase (ALT)) in patients with nonmetastatic renal cell carcinoma (RCC) following radical nephrectomy. Methods We retrospectively reviewed the records of 670 patients who underwent radical nephrectomy for nonmetastatic RCC between 1996 and 2012 at our institution. The cutoff points for preoperative (=1.0) and postoperative AST/ALT ratios (=1.12) were assigned based on the median values. We categorized patients into four groups according to the dynamics of AST/ALT ratios: group 1 (lower (≤1.0) ⟶ lower (≤1.12)), group 2 (lower (≤1.0) ⟶ higher (>1.12)), group 3 (higher (>1.0) ⟶ lower (≤1.12)), and group 4 (higher (>1.0) → higher (>1.12)). Results When grouped by a preoperative AST/ALT ratio alone, the groups were not statistically different in cancer-specific survival (CSS) or overall survival (OS). In contrast, in Kaplan-Meier analysis, CSS (P = 0.0296) and OS (P = 0.0324) were both significantly shorter with an increased postoperative AST/ALT ratio. According to the pre-to-postoperative dynamics of the AST/ALT ratio, group 2 (lower (≤1.0) ⟶ higher (>1.12)) had a significantly lower CSS (P = 0.0028) and OS (P = 0.0194) than the other groups. On multivariate Cox regression analysis, the pre-to-postoperative dynamics of the AST/ALT ratio were a significant prognostic factor for CSS (hazard ratio, HR = 3.45) and OS (HR = 2.18). Conclusion This study is the first to suggest that the dynamics of the pre-to-postoperative De Ritis ratio represent an independent prognostic factor for RCC patients following nephrectomy.

Enzyme Activity and De Ritis Ratio in Alcoholic and Non Alcoholic Fatty Liver Patients based on Ultrasonography

INTRODUCTION: Fatty liver disease (FLD) refers to a wide clinical and histological spectrum from simple hepatic steatosis to steatohepatitis or cirrhosis, and FLD has been classified as nonalcoholic FLD (NAFLD) and alcoholic FLD (AFLD) based on etiology and ultrasonography (USG).&#x0D; MATERIAL AND METHODS: This Cross-sectional study was undertaken in the Department of Radiology, Universal College of Medical Sciences (UCMS), Bhairahawa, Nepal from March 2019 to February 2020. A total of 100 subjects involved where ultrasonographically graded for fatty liver and enzyme activity were assessed to observe their association.&#x0D; RESULTS: In 100 cases, 66% were male and 34% were female. Ultrasonography (USG) guided FLD grade 1 patients were 81%, FLD grade 2 patients were 19% where as no cases was observed for FLD grade 3. Fifty Six percent (56%) of the total cases presented with AFLD while remaining 44% with NAFLD. There was significant difference in serum glutamate oxaloacetate transaminase (SGOT) (p-value: 0.003), serum glutamate pyruvate transaminase (SGPT) (p-value: 0.011) and alkaline phosphatase (ALP) (p-value: 0.003) in AFLD and NAFLD. However, there was no significant association of enzyme activity with FLD grade (p-value &gt;0.05). There was significant difference in SGOT (p-value: 0.004), SGPT (p- value: 0.025) between AFLD grade 1 (AFLDG1) and NFLD grade 1 (NAFLDG1), SGOT (p-value: 0.016) between AFLDG2 and NAFLDG2 and ALP (p-value: 0.01) between AFLDG1 and NAFLDG1. However, De Ritis ratio was not significantly associated with fatty liver disease.&#x0D; CONCLUSION: USG is a non-invasive simple tool for early detection of fatty liver in asymptomatic patients enabling clinicians to achieve early detection in conjunction with hepatic enzymes.

PT359 - Prognostic value of preoperative De Ritis ratio in upper tract urothelial carcinoma treated with radical nephroureterectomy

PT359 - Prognostic value of preoperative De Ritis ratio in upper tract urothelial carcinoma treated with radical nephroureterectomy

Protective Effect of Flaxseed on the Health of Experimental Animals Exposed to Xylene

Abstract Xylene is mainly used as a solvent in the printing, tire and leather industries. It is also used as: a facility cleaner, paint and varnish thinner, component of fuel, and chemical for the laboratory processing of histological preparations. For these reasons people are frequently exposed to xylene and the risk of intoxication is high. This study focused on the protective effect of flaxseed on mice experimentally intoxicated with xylene. The experiment lasted 14 days. The mice used in this study (n = 60) were allocated to 3 groups: the control group (C) received only the standard diet; the xylene group (X) was fed a standard diet and was administered xylene p. o. (10 µl daily); and the xylene + flaxseed group (XF) received the standard feed, crushed flaxseed and xylene at the same dose as group X. The observations involved changes in: body weight, liver enzyme levels, and caspase activity in the liver of the mice. The administration of additives resulted in significant changes in the body weight of the mice on day 7 of the experiment (P &lt; 0.05). The highest weight gain was observed in mice from the XF group. In contrast, the body weight of the mice from group X exposed only to xylene was the lowest. The biochemical analysis of the liver cells of the xylene intoxicated mice showed elevated levels of: aspartate aminotransferase (AST), De Ritis ratio (AST/ALT ratio), and lactate dehydrogenase isoenzymes LDH-3 and LDH-5. Caspase-3, the marker of apoptosis, was increased in the XF group. Thus, the administration of flaxseed in our experiment had a beneficial effect on the clinical and metabolic parameters of mice intoxicated with xylene. Our results indicated that the administration of flaxseed, may act as a preventative measure with respect to xylene intoxication of animals; however, further analyses are needed to confirm this assumption.

Impact of Serum γ-Glutamyltransferase on Overall Survival in Patients with Metastatic Renal Cell Carcinoma in the Era of Targeted Therapy.

γ-Glutamyltransferase (GGT) is a marker of oxidative stress. Elevated serum GGT is linked to poor survival in various malignancies; however, there are no data on metastatic renal cell carcinoma (mRCC). Additionally, GGT expression in cancer tissues remains largely unknown. The present study was designed to determine the prognostic role of serum GGT in patients with mRCC and the association between systemic and local GGT levels. Pretherapeutic serum GGT and other clinicopathological parameters were retrospectively compared with overall survival (OS) in 146 consecutive patients with mRCC receiving tyrosine kinase inhibitor therapy. GGT expression was analyzed in 65 resected specimens using immunohistochemistry. A total of 82 patients (56%) died during the follow-up period (median 34.9months). Median OS was 16.0months and 36.8months in patients with elevated GGT levels and without elevated GGT, respectively (P < 0.001). On multivariable analysis, elevated serum GGT was an independent adverse prognostic factor (hazard ratio [HR] 4.04, P < 0.001), together with high neutrophils (HR 2.06, P = 0.041), low albumin (HR 2.00, P = 0.006), high lactate dehydrogenase (HR 2.68, P < 0.001), and high De Ritis ratio (HR 1.97, P = 0.004). Preoperative serum GGT levels were 29, 48, and 109 U/l in patients whose renal cancer cells showed negative to weak, moderate, and strong GGT expression, respectively (P = 0.004). Elevated serum GGT was an unfavorable prognostic factor in mRCC, and overexpression of GGT in renal cancer cells might be responsible for elevation of serum GGT.

Effect of Bathing in a 0.1% Aqueous Solution of Ethacridine Lactate on Selected Physiological Parameters of Cornu Aspersum Müller Edible Snails.

IntroductionThe prohibition of antibiotic use in edible snails obligates breeders to treat bacterial infections by different means, of which a common one is a bath in Gram-positive– and partially Gram-negative–bactericidal ethacridine lactate solution. The aim of the study was to determine the effect of bathing Cornu aspersum Müller snails in a 0.1% aqueous solution of ethacridine lactate on selected physiological parameters of haemolymph.Material and MethodsThe study included 80 snails, divided into two equal groups (study and control). The study group was subjected to bathing in ethacridine lactate and the control group to bathing in tap water. Both groups were treated daily for seven days. The number of haemocytes in the haemolymph, the activity of alanine (ALT) and aspartate (AST) aminotransferases, and the concentration of urea were determined.ResultsIn the study group, after exposure to ethacridine lactate solution an increase in ALT activity, changes in the De Ritis ratio, an increase in the amount of haemocytes, and a decrease in body weight were found. No such changes were detected in the control group snails or in animals after the first bath.ConclusionMultiple applications of a 0.1% ethacridine lactate bath may adversely affect Cornu aspersum Müller snails.

Prognostic value of De Ritis ratio (aspartate transaminase/alanine transaminase) in patients with non-metastatic colorectal carcinoma [izmir oncology group(IZOG) study

e16114 Background: We aimed to assess the prognostic effect of preoperative De Ritis (aspartate aminotransaminase/Alanine aminotransaminase) ratio and pathological variables to find out whether it is an independent prognostic factor in patients with non-metastatic CRC. Methods: We retrospectively evaluated the patients who underwent curative surgery for non-metastatic CRC between 2006 and 2017. The potential prognostic value of De Ritis ratio was assessed by using a ROC curve analysis. The effect of the De Ritis ratio was analyzed by the Kaplan–Meier method and Cox regression hazard models for patients’ disease-free survival (DFS) and overall survival (OS). Results: We had 921 CRC patients in total. The univariate analysis demonstrated that low De-Ritis ratio and several well-established prognostic factors, including well-differentiated tumor,negative lymph node involvement, lymphatic invasion, perineural invasion and surgical margin, left tumor localization and early-stage tumor were good prognostic factors in terms of DFS and OS. On the multivariate analysis, De-Ritis ratio, lymph node involvement, perineural invasion status, surgical margin statusand tumor localization were independent prognostic factors for DFS [ De-Ritis ratio HR 0.468, 95% CI 0.358-0.613,p &lt; 0.001]. We also found that De-Ritis ratio, degree of differentiation, lymphatic invasion status, perineural invasion statusand stage were independent prognostic factors for OS on multivariate analysis [ De-Ritis ratio HR 0.354, 95% CI 0.407-0.702, p &lt; 0.001]. Conclusions: Our study first established a connection between the preoperative De-Ritis ratio and patients undergoing curative resection for non-metastatic colorectal cancer, suggesting that De-Ritis ratio was a simple, inexpensive, and easily measurable marker as a prognostic factor and may help to identify high-risk patients for treatment decisions.

The utility of De Ritis Ratio in predicting prognosis in testicular cancer

The utility of De Ritis Ratio in predicting prognosis in testicular cancer

Прогнозування тяжкості розладів унаслідок уживання алкоголю у хворих залежно від рівня психосоціального стресу і стану гепатобіліарної системи у світлі концепції інтегрованої діагностики й терапії наркопатології

Розробляли спосіб визначення і прогнозування тяжкості розладів, що виникають унаслідок уживання алкоголю, у хворих залежно від рівня психосоціального стресу і стану гепатобіліарної системи у світлі концепції інтегрованої діагностики й терапії наркопатології для використання його лікарями первинної ланки медико-санітарної допомоги. При розробці моделі виділено три основні групи факторів, які, за отриманими даними, мали вплив на формування тяжкості розладів унаслідок уживання алкоголю: вираженість адиктивної симптоматики (за AUDIT), рівень випробовуваного пацієнтами стресового навантаження (за тестом Л. Рідера) та стан гепатобіліарної системи (за коефіцієнтом де Рітіса). Створено модель, яка математично описує співвідношення різних факторів у формуванні тяжкості розладів, що розвиваються внаслідок уживання алкоголю, і дає можливість кількісно оцінити ймовірнісний стан у конкретного хворого на розлади внаслідок уживання алкоголю. Показано, що запропонована модель характеризується високою детермінантністю і придатна для застосування у практиці охорони здоров’я для прогнозування тяжкості розладів унаслідок уживання алкоголю у хворих на алкогольну залежність.

The utility of De Ritis Ratio in predicting prognosis in testicular cancer

We aimed to investigate the possible association between testicular cancer prognosis and De Ritis ratio (AST/ALT). The medical records of all patients who underwent radical inguinal orchiectomy at a single tertiary in Istanbul, Turkey between 2006 and 2017 were retrospectively analyzed. Investigated parameters included patients' demographics, complete blood count and blood biochemistry results, pathology results, treatment schemes, imaging results, and survival. De Ritis ratio was calculated as follows: AST/ALT. A total of 171 patients with a mean age of 32.6 ± 10.1 years were included in the study. 73 patients had T1, 83 had T2, 13 had T3 and 2 had T4 disease. Rete testis invasion was detected in 74 patients (43.3 %) as well as lymphovascular invasion in 93 (54.4 %) and tunica albuginea invasion in 80 (46.8 %) patients. The cut-off value for AST/ALT was set at 1.35 [Area Under Curve (AUC): 0.791 with a sensitivity of 80 % and specificity of 73 %]. No statistically significance was observed between patients with and without elevated AST/ALT according to rete testis invasion, lymphovascular invasion, tunica albuginea invasion, and tunica vaginalis invasion (p = .25, p = .63, p = 1.0 and p = 1.0, respectively). 28.2 % of patients with seminoma had AST/ALT > 1.35 however 41.9 % of patients with non-seminoma pathology had AST/ALT > 1.35 (p = .078). Mean estimated survival time of patients with AST/ALT > 1.35 was higher than those with AST/ALT < 1.35, 91.8 versus 70.4 months, p < .001). As seen in Kaplan-Meier analysis elevated AST/ALT is associated with early-term mortality. De Ritis ratio was shown to be significantly associated with unfavorable prognosis. De Ritis ratio might serve as a prognostic biomarker in testicular tumor besides well-known tumor markers such as beta-human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH).

Prognostic role of preoperative De Ritis ratio in upper tract urothelial carcinoma treated with nephroureterectomy

PurposeTo validate the predictive and prognostic role of the De Ritis ratio in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy in a large multi-institutional cohort. Materials and methodsThe preoperative De Ritis ratio was assessed in a multi-institutional cohort of 2,492 patients. An altered De Ritis ratio was defined as a ratio >1.35. Logistic regression analyses were performed to assess the association of the De Ritis ratio with advanced disease. The association of the De Ritis ratio with survival outcomes was evaluated using Cox proportional hazards regression models. ResultsAn altered De Ritis ratio was observed in 985 (41.5%) patients; it was associated with a more advanced pathological features. In a preoperative model, the De Ritis ratio was an independent predictive factor for the presence of lymph node metastasis and muscle-invasive and nonorgan-confined disease (P < 0.05). Compared to patients with a normal De Ritis ratio, those with an altered De Ritis ratio had worse recurrence free (P <0.0001), cancer specific (P = 0.0003), and overall survival (P = 0.0014) in the Kaplan-Meier analyses. In the multivariable analyses that was adjusted for the effects of standard clinicopathologic features, the De Ritis ratio did not retain its independent prognostic value. ConclusionsIn UTUC, the preoperative De Ritis ratio is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC. Therefore, it might be useful to incorporate the De Ritis ratio into prognostic tools in selecting appropriate treatment strategies.

Dependence of changes in hematological and integrative parameters in patients with chronic viral hepatitis C on the received antiviral therapy

A total of 287 patients were treated with various antiviral therapy options: group I – basic (pathogenetic and symptomatic) therapy, group II – pegylated interferon in combination with ribavirin, group III – pegylated interferon with ribavirin and sofosbuvir, group IV – direct-acting antivirals. Patients with chronic viral hepatitis C (CVHC) before the start of treatment showed a decrease in platelet counts, segmented neutrophils and an increase in level of lymphocytes, bilirubin content, alanine aminotransferase activity, aspartate, transferrinase (practice), with a comparison group (practically virus-free patients) &lt;0.05. After 4 weeks of receiving interferon-containing therapy, a further decrease was observed: leukocyte count, erythrocyte count, platelet count; ALT, AST and gamma-glutamyltranspeptidase (GGTP) activity; increased erythrocyte sedimentation rate (ESR), bilirubin content, and bilirubin activity p&lt; 0.05. Patients who received direct-acting antivirals (DAAs) had a decrease in: erythrocyte count, total bilirubin content, ALT activity, AST, GGTP; increase in sed rate and the AST/ALT ratio, p &lt;0.05. After 12 weeks of treatment, patients treated with pegylated interferon were diagnosed with a decrease in platelet count, erythrocyte count, and leukocyte count (with the exception of patients with dual therapy that experienced the slight increase of the leukocytes) with hemoglobin content, p &lt;0.05. Also, in the group II subjects compared with week 4 decreased: the content of bilirubin and creatinine, the activity of ALT, AST, GGTP, while the De Ritis ratio increased (p &lt;0.05). Patients in group III had lower GGTP activity than at 4 weeks and lower ALT and AST values compared with the onset of antiviral therapy (p &lt;0.05). Patients receiving DAAs experienced a decrease in hemoglobin content; no changes in biochemical parameters at this stage compared with the previous one were established.The investigated integrative indicators suggest changes in the immune system of patients, in particular the prevalence of cellular immunity over the humoral link and the predominance of the autoimmune component. Patients with dual and triple PVT regimens had more pronounced changes compared to patients receiving DAAs.

Clinical course features of non-alcoholic steatohepatitis on obesity background in comorbidity with chronic obstructive pulmonary disease

Objective: to elucidate clinical, ultrasonographic, and biochemical features of the course of non-alcoholic steatohepatitis (NASH) for comorbidity with grade 1 obesity, chronic obstructive pulmonary disease (COPD) of 2–3 D stages compared with NASH during obesity without COPD by studying the frequency and intensity of leading clinical and biochemical syndromes of NASH, comparison of ultrasonographic (USG) characteristics of NASH depending on the presence of COPD. Material and methods. 105 NASH patients were examined: 52 NASH patients with grade 1 obesity (1 group) (there were 18 men, 24 women); 53 NASH patients with comorbid grade 1 obesity and COPD of 2–3 D stages (group 2) (there were 28 men, 13 women). In order to determine the dependence of NASH on the presence of COPD, groups of patients were randomized by the age and the degree of obesity. The average age of the patients was (55,7 ± 3,22) years. The functional condition of the liver was determined by the generally accepted lists of enzyme activity, markers of pigment and nitrogen metabolism, proteinograms, lipidograms, ionograms, calculation of de Ritis ratio, and the USG was performed. In order to quantify the changes in liver echogenicity we have used the method of echodensitometry with the calculation of the hepatorenal index. Results. The symptoms of astheno-vegetative syndrome, dyspepsia and feeling of heaviness or pain while palpating in the right hypochondrium were observed in 2,1 times, 1,7 times and 2,5 times (p<0,05) more often in patients of the 2nd group in comparison with patients of the 1st group. Clinically, in NASH patients the syndrome of cholestasis was found in 28.8%, in comparison with NASH patients and COPD (in 62,3%). In patients of the 2nd group, the frequency of splenomegaly exceeded the indicator in the 1st group, respectively, in 2.7 times (p<0.05). Among the biochemical syndromes in the examined patients of the 2nd group was found cytolytic (100,0%), cholestatic (73,6%) syndromes, which exceeded the frequency in the 1st group in 2,3 times (p<0,05), mesenchymal inflammatory, which occurred more often as compared to the 1st group — in 1.9 times (p<0,05), and hepatocellular failure (HF) syndrome (50,9%), which occurred more often in comparison with the 1st group — in 2,6 times (p<0,05). Conclusion. The clinical course of non-alcoholic steatohepatitis for comorbidity with obesity is characterized by a high frequency and intensity of clinical syndromes, the manifestation of which increases significantly with the addition of COPD 2–3 D namely: astheno-vegetative, abdominal pain, portal hypertension, splenomegaly, cholestasis, as well as the frequency and intensity of biochemical syndromes namely: mesenchymal inflammation, cholestasis, hepatocellular failure.

Association of De Ritis Ratio and Neutrophil Lymphocyte Ratio with renal functional decline and all-cause mortality in renal cell carcinoma.

741 Background: We sought to investigate utility of pre-operative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis Ratio as predictors of all-cause mortality (ACM) and renal functional decline renal cell carcinoma (RCC). Methods: Multi-institutional retrospective analysis of patients undergoing surgery for RCC. Multivariable analysis (MVA) was conducted to elucidate independent risk factors for ACM, de novo estimated glomerular filtration rate (eGFR)&lt;45 ml/min/1.73m2 and eGFR&lt;30 ml/min/1.73m2. Kaplan-Meier analysis (KMA) was used to investigate ACM, and de novo CKD. Results: 2928 patients were analyzed [1850 Male/1078 Female, median follow up 30.5 months, median tumor size 4.5 cm, 1741 partial nephrectomy (PN)/1187 radical nephrectomy (RN)]. 690 patients had NLR ≥ 3, while 208 patients had NLR ≥ 6; 110 patients had PLR ≥ 3; and 474 patients had De Ritis Ratio ≥ 3. MVA for risk factors associated with worsened ACM showed male sex (OR 1.6, p=0.02), HTN (OR 2.1, p=0.001), increasing tumor size (OR 1.12, p&lt;0.001), clear cell RCC (OR 2.0, p=0.001), RN (OR 1.6, p=0.048), NLR≥ 6 (OR=2.4, p=0.001), Di Ritis Ratio≥3 (OR 2.4, p&lt;0.001), and de novo eGFR&lt;45 (OR=1.6, p=0.015) to be independent risk factors. MVA for factors associated with development of eGFR&lt;45 included increasing age (OR 1.03, p&lt;0.001), male (OR 1.5, p=0.01), HTN (OR 2.3, p&lt;0.001), clear cell RCC (OR 2.2, p&lt;0.001), RN (OR 6.8, p=0.03), NLR≥6 (OR 2.0, p=0.002), and Di Ritis Ratio≥3 (OR 2.3, p&lt;0.001) to be independently associated. Variables associated with development of eGFR&lt;30 included age (OR 1.05, p&lt;0.001), DM (OR=3.01, p&lt;0.001), black race (OR 1.9, p=0.005), Di Ritis Ratio≥3 (OR 2.0, p=0.001), and NLR≥6 (OR 2.1, p=0.002). PLR was not associated with OS, de novo eGFR&lt;45, or de novo eGFR&lt;30. On KMA, NLR≥6 was associated with worse OS (p&lt;0.001). Di Ritis ratio ≥1.5 was associated with worse OS p&lt;0.001 and Di Ritis ratio (≥3) was associated decreased freedom from of de novo eGFR&lt;45 (p=0.026). Conclusions: Elevated NLR and De Ritis Ratio were associated with functional decline and worsened OS, while PLR was not predictive. These markers may be helpful in identifying high-risk patients.