De Ritis Ratio Research Articles

De Ritis score as an inflammatory marker in Hashimoto's thyroiditis

AbstractBackgroundThe aim of the study was assessing the De Ritis score, an inflammatory marker, in Hashimoto's thyroiditis (HT) patients which is characterized with autoimmunity and chronic inflammation.MethodsBetween October 2021 and October 2022, the subjects in our outpatient clinics diagnosed with thyroiditis and healthy controls enrolled to the study. Age, gender, and laboratory parameters including C‐reactive protein (CRP), alanine (ALT), and aspartate (AST) transaminases, thyroid stimulating hormone (TSH), free T4 (FT4), were obtained and recorded for all participants, retrospectively. Division of AST by ALT was the formula to calculate the De Ritis score. Characteristics and laboratory data of the study and healthy controls were compared.ResultsMedian de Ritis ratio of the HT group (1.11 (0.56)%) was significantly higher than that of the control group (0.91 (0.41)%), (p < .001). A positive and significant correlation between De Ritis score and CRP (r = 0.46, p < .001) values. ROC analysis revealed the sensitivity and the specificity of CRP in predicting HT were higher than those of the De Ritis score. A De Ritis score higher than 0.9% has 67% sensitivity and 50% specificity in selecting patients with thyroiditis (AUC: 0.69, p < .001, 95% CI: 0.63–0.76).ConclusionsWe think that elevated De Ritis score can be used as an adjunctive tool in the diagnosis of HT.

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.

Patients with Coronavirus disease 2019 (COVID-19) often have elevations in markers of liver injury, particularly serum aspartate transaminase (AST) and alanine transaminase (ALT). Such alterations may affect the AST/ALT ratio (De Ritis ratio) and, potentially, clinical outcomes. We conducted an updated systematic review and meta-analysis of the association between the De Ritis ratio and COVID-19 severity and mortality in hospitalized patients. PubMed, Web of Science, and Scopus were searched between 1 December 2019 and 15 February 2023. The Joanna Briggs Institute Critical Appraisal Checklist and the Grading of Recommendations, Assessment, Development, and Evaluation were used to assess the risk of bias and the certainty of the evidence, respectively. Twenty-four studies were identified. The De Ritis ratio on admission was significantly higher in patients with severe disease and non-survivors vs. patients with non-severe disease and survivors (15 studies, weighted mean difference = 0.36, 95% CI 0.24 to 0.49, p < 0.001). The De Ritis ratio was also associated with severe disease and/or mortality using odds ratios (1.83, 95% CI 1.40 to 2.39, p ˂ 0.001; nine studies). Similar results were observed using hazard ratios (2.36, 95% CI 1.17 to 4.79, p = 0.017; five studies). In six studies, the pooled area under the receiver operating characteristic curve was 0.677 (95% CI 0.612 to 0.743). In our systematic review and meta-analysis, higher De Ritis ratios were significantly associated with severe disease and mortality in COVID-19 patients. Therefore, the De Ritis ratio can be useful for early risk stratification and management in this patient group (PROSPERO registration number: CRD42023406916).

The Association of De Ritis Ratio with the Severity of Crimean–Congo Hemorrhagic Fever

Aim: This study aimed to present the characteristics and poor prognostic factors of Crimean–Congo hemorrhagic fever (CCHF) patients. Materials &amp; methods: Adult patients (&gt;18 years) with CCHF were included in this retrospective study. Demographics, risk scores and laboratory findings of survivors and nonsurvivors were compared. Results: Fifteen (9.2%) of 163 CCHF patients were nonsurvivors and had a higher Severity Score Index (p &lt; 0.001), Severity Grade Score (p &lt; 0.001) and De Ritis ratio (aspartate transaminase/alanine transaminase) (p &lt; 0.001). De Ritis ratio was &gt;3 in 10.1% of survivors and 53.3% of nonsurvivors (p &lt; 0.001). In multivariate analysis, De Ritis ratio &gt;3 (OR: 5.428, p = 0.045) and SGS (OR: 1.776, p = 0.005) were found as predictive factors. Conclusion: De Ritis ratio may predict prognosis in combination with severity risk scores in CCHF.

De Ritis oranının akut kolesistitteki rolü: retrospektif gözlemsel çalışma

Aim&#x0D; Our study aimed to evaluate the relationship between the De-Ritis ratio and prognosis and mortality in patients diagnosed with cholecystitis. &#x0D; Materials and Methods&#x0D; This retrospective observational study was conducted on patients diagnosed with acute cholecystitis who presented to the emergency medical clinic of XXX Hospital between June 1, 2020, and January 1, 2022. The Statistical Package for Social Sciences (SPSS) software (v.20; Chicago, IL, USA) was used for all statistical analyses. All results with p &lt; 0.05 were considered statistically significant.&#x0D; Results&#x0D; In our study, 174 patients were included, and 50.6% of our patients were women. The mean age was 59.0 (43.2 to 71.8). A total of 2.29% of our patients died. No statistically significant relationship was found between AST, ALT, CRP, albumin, and the De-Ritis ratio and mortality (p=0.584, p=0.533, p=0.517, p=0.07, p=0.399, respectively). When mortality rates in operated patients were examined, no statistically significant correlation was found between AST, ALT, CRP, albumin, and De-Ritis rates and mortality (p=0.248, p=0.315, p=0.451, p=0.183, p=0.688, respectively)&#x0D; Conclusion&#x0D; To the best of our knowledge, no study has examined the relationship between cholecystitis and the De-Ritis ratio. De-Ritis ratio is not used as a prognostic marker in patients with cholecystitis.

Inflammatory risk stratification individualizes anti-inflammatory pharmacotherapy for acute type A aortic dissection

The systemic benefits of anti-inflammatory pharmacotherapy vary across cardiovascular diseases in clinical practice. We aimed to evaluate the application of artificial intelligence to acute type A aortic dissection (ATAAD) patients to determine the optimal target population who would benefit from urinary trypsin inhibitor use (ulinastatin). Patient characteristics at admission in the Chinese multicenter 5A study database (2016-2022) were used to develop an inflammatory risk model to predict multiple organ dysfunction syndrome (MODS). The population (5,126 patients from 15 hospitals) was divided into a 60% sample for model derivation, with the remaining 40% used for model validation. Next, we trained an extreme gradient-boosting algorithm (XGBoost) to develop a parsimonious patient-level inflammatory risk model for predicting MODS. Finally, a top-six-feature tool consisting of estimated glomerular filtration rate, leukocyte count, platelet count, De Ritis ratio, hemoglobin, and albumin was built and showed adequate predictive performance regarding its discrimination, calibration, and clinical utility in derivation and validation cohorts. By individual risk probability and treatment effect, our analysis identified individuals with differential benefit from ulinastatin use (risk ratio [RR] for MODS of RR 0.802 [95% confidence interval (CI) 0.656, 0.981] for the predicted risk of 23.5%-41.6%; RR 1.196 [0.698-2.049] for the predicted risk of <23.5%; RR 0.922 [95% CI 0.816-1.042] for the predicted risk of >41.6%). By using artificial intelligence to define an individual's benefit based on the risk probability and treatment effect prediction, we found that individual differences in risk probability likely have important effects on ulinastatin treatment and outcome, which highlights the need for individualizing the selection of optimal anti-inflammatory treatment goals for ATAAD patients.

Clinical value of acoustic radiation force impulse elastography in the prediction of hepatocellular carcinoma in chronic hepatitis C patients

Background and purpose of the studyAcoustic radiation force impulse elastography (ARFI) represents an innovative non-invasive tool for the evaluation of liver fibrosis, cirrhosis, and early identification of neoplastic nodules during the follow-up of cirrhotic patients; however, its diagnostic accuracy in the prediction of hepatocellular carcinoma (HCC) is still controversial.Purpose of the studyTo assess the potential role of ARFI elastography as a non-invasive tool for the prediction of HCC development among chronic hepatitis C (CHC) patients with advanced hepatic fibrosis and liver cirrhosis.MethodsThe present study recruited 440 patients: 349 CHC patients with advanced hepatic fibrosis and cirrhosis and 91 patients with HCC-related hepatitis C virus (HCV). ARFI-imaging of the liver and transient elastography (TE) was carried out in all patients. ARFI imaging indices include the mean shear wave velocity of HCC, peritumoral parenchyma, and hepatic parenchyma in non-HCC patients. The area under the receiver operating characteristic curve (AUROC) and optimal cutoff values were obtained using a receiver operating characteristic curve analysis to assess the diagnostic performance of ARFI elastography in the predication of HCC.ResultsThe mean hepatic shear wave velocities by ARFI elastography of peri-tumoral cirrhotic hepatic parenchyma were significantly higher than in hepatic parenchyma in non-HCC patients (3.09 vs. 2.26 m/s, p <0.001). The AUROC for the identification of HCC was 0.8, 0.76, 0.76, 0.66, 0.72, and 0.7 for hepatic ARFI elastography, TE, fibrosis-4 score (FIB-4), AST to Platelet Ratio Index (APRI), AST/ALT ratio (AAR), and Age platelets index (API), respectively. Moreover, univariate regression analysis revealed that hepatic ARFI has the highest odd ratio in the prediction of HCC.ConclusionARFI elastography had a superior diagnostic performance in the prediction of HCC compared to TE and non-invasive markers in CHC patients with advanced fibrosis and cirrhosis, thus putting such patients on the top of the HCC screening list.

A High De Ritis Ratio is Associated with Mortality in Adult Trauma Patients.

The De Ritis ratio, which is the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), has been suggested as a potential prognostic marker for various diseases. This study aimed to investigate the association between the De Ritis ratio and in-hospital mortality in adult trauma patients. A total of 17,472 adult trauma patients hospitalized between January 1, 2009, and December 31, 2020, were allocated into groups according to the De Ritis ratio. The normal range of the De Ritis ratio was calculated from 3320 individuals in the National Taiwan Biobank. Statistical analyses were performed using SPSS software. Patients with a De Ritis ratio >1.6 had a significantly higher in-hospital mortality rate (7.3% vs 1.5%, odds ratio 5.29; Q1-Q3 2.72-10.30; p < 0.001) and a 2.71-fold higher in-hospital mortality rate (Q1-Q3 1.24-5.92; p = 0.012), after adjusting for sex, age, comorbidities, consciousness level, and injury severity, than those with a De Ritis ratio within the reference values. This study revealed that a De Ritis ratio >1.6 may serve as an early prognostic tool to identify adult trauma patients at high risk of in-hospital mortality.

Association of De Ritis Ratio with Prognosis in Patients with Coronary Artery Disease and Aminotransferase Activity within and outside the Healthy Values of Reference Range.

The aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (De Ritis ratio), obtained from AST and ALT activities in the healthy range, has not been studied in association with mortality. This study included 3392 patients with stable coronary heart disease and aminotransferase activity in the reference range. Patients are categorized into two groups: a group with AST and ALT activity in the healthy range (n = 1697), and a group with AST and/or ALT activity outside the healthy range but in the reference range (n = 1695). The primary endpoint was all-cause mortality at three years. The De Ritis ratio (median 5th-95th percentile] was 0.94 [0.61-1.41] in patients with AST and ALT in the healthy range and 0.93 [0.45-1.96] in patients with AST and/or ALT outside the healthy range (p = 0.700). At three years, there were 86 deaths in patients with AST and ALT in the healthy range: 27 deaths (3.9%) in patients with a De Ritis ratio ≤median, and 59 deaths (8.2%) in patients with the De Ritis ratio >median (adjusted hazard ratio [HR] = 1.16, 95% confidence interval [CI] 0.94 to 1.42; p = 0.159); in patients with AST and/or ALT outside the healthy range, there were 148 deaths: 49 deaths (6.6%) in patients with a De Ritis ratio ≤median, and 99 deaths (14.1%) in patients with De Ritis ratio >median (adjusted HR = 1.27 [1.09-1.48], p = 0.002), with both HRs calculated per unit higher values of the De Ritis ratio. The De Ritis ratio obtained from AST and ALT activity in the healthy range was not independently associated with higher risk of mortality. The De Ritis ratio obtained from aminotransferase activity outside the healthy range (but still in the reference range) was independently associated with the risk of mortality.

Effect of azodicarbonamide on rats with a high-fat hypercaloric diet

Azodicarbonamide is an important chemical widely used in the industry as a blowing agent in the foam industry and in the food industry as a flour bleaching agent and a dough conditioner. The discussion about its biosafety is ongoing, in a number of countries, the use of azodicarbonamide is limited or even prohibited since a slightly carcinogenic effect of its by-products has been found. Despite this, many manufacturers continue to use it as a food additive. In a laboratory experiment, the effect of various doses of azodicarbonamide on the organism of laboratory animals under the background of a high-fat diet was determined by changes in their body weight, the state and mass indices of internal organs, blood parameters, the functional state of the nervous system, and changes in the intestinal microbiota. Four groups were formed from laboratory male rats, which for 21 days were consuming: a high-fat diet with the addition of 4%, 1%, 0.25%, 0% azodicarbonamide. It has been determined that azodicarbonamide did not cause a change in the organ mass index, but the addition of 4% and 1% of the substance to the diet significantly reduced the intensity of animals' body weight gain. Both excess fat in the diet and different doses of azodicarbonamide mainly caused functional disorders of the parenchymal organs, as evidenced by changes in the activity of blood enzymes (Aspartate aminotransferase, Alanine aminotransferase, De Ritis ratio (AST/ALT), Alkaline phosphatase) and protein metabolism (Total protein, Globulins, Protein coefficient, Urea). Significant changes in the physical and orientation activity and emotional status of the animals were not observed. Low concentrations of azodicarbonamide (0.25% and 1% of the feed mass) caused a pronounced decrease in the number of normal enzymatic properties of Escherichia coli strains below the control group and the reference range, and a high concentration (4%) significantly reduced the number of Lactobacillus bacteria in comparison with the control one but did not exceed references.

Relationship between the Serum De Ritis Ratio and Diabetes Tests in Korean Adults Who Underwent Health Screening at a General Hospital in Gyeonggi-do

Relationship between the Serum De Ritis Ratio and Diabetes Tests in Korean Adults Who Underwent Health Screening at a General Hospital in Gyeonggi-do

Predicting Early Graft Dysfunction and Mortality After Liver Transplant Using the De Ritis Ratio

Predicting complications after liver transplantation (LT) remains challenging. We propose incorporating the De Ritis ratio (DRR), a widely known parameter of liver dysfunction, into current or future scoring models to predict early allograft dysfunction (EAD) and mortality after LT. A retrospective chart review was conducted on 132 adults receiving a deceased donor LT from April 2015 to March 2020 and their matching donors. Donor variables, postoperative liver function, and DRR were correlated with the occurrence of EAD, post-transplant complications expressed by the Clavien-Dindo score, and 30-day mortality as outcome variables. Early allograft dysfunction was observed in 26.5% of patients and 7.6% of patients who died within 30 days after transplant. Recipients were more likely to experience EAD when receiving grafts from donation after circulatory death (P=.04), donor risk index (DRI) >2 (P=.006), ischemic injury at time-zero biopsy (P=.02), longer secondary warm ischemia time (P < .05), or higher Clavien-Dindo scores (IIIb-V; P < .001). The DRI, total bilirubin, and DRR on postoperative day 5 yielded significant associations with the primary outcomes and were used to develop the Gala-Lopez score using a weighted scoring model. This accurately predicted EAD, high Clavien-Dindo, and 30-day mortality in 75%, 81%, and 64% of patients. Including recipient and donor variables in predictive models, and for the first time DRR, as a constituent, should be regarded to predict EAD, severe complications, and 30-day mortality post-LT. Further studies will be required to validate the present findings and their applicability when using normothermic regional and machine perfusion technologies.

Preoperative De Ritis Ratio for the Evaluation of Recurrence and Progression in Non-muscle Invasive Bladder Cancer

Preoperative De Ritis Ratio for the Evaluation of Recurrence and Progression in Non-muscle Invasive Bladder Cancer

Transaminase Enzyme Activity and Histopathology Evaluation of Rat’s Liver Induced by DMBA with Temulawak Extract (Curcuma xanthorrhiza)

Temulawak rhizome (Curcuma xanthorrhiza) contains curcumin and xanthorrhizol, which may be used as breast cancer drugs and hepatoprotection. This study aims to analyze the activity of alanine and aspartate transaminase enzymes and the histopathological picture of 7,12-Dimethylbenz(α)anthracene (DMBA)-induced rat liver due to the administration of temulawak extract. This study used 28 female white rats, divided into seven treatment groups, a control group (normal and DMBA) and a treatment group induced by temulawak extract orally with doses of 35, 70, 140, 210, and 280 mg/kg Body Weight (BW) during the 11-week study period. The results obtained were that the application of temulawak extract had a significant effect on alanine transaminase (ALT) levels but did not differ between groups. Aspartate transaminase (AST) levels differed at a 35 mg/kg BW dose. Temulawak extract at a dose of 140 mg/kg BW, the De Ritis ratio at normal values. The results of the histopathological analysis showed hepatocyte repair and sinusoidal dilatation were less than optimal at a dose of 140 mg/kg BW. This study concluded that the temulawak extract showed a significant but insignificant difference in the ALT value. The AST value significantly differed in administering temulawak extract at a dose of 35 mg/kg BW. The dose of 140 mg/kg BW controls the value of the De Ritis ratio to the normal value. Temulawak extract is expected to improve the healing of the liver damaged by carcinogenic substances.

THE SIGNIFICANCE OF TRANSAMINASES AND DERITIS RATIO FOR PREDICTING ALCOHOLIC LIVER DISEASE

Background: A signicant public health issue is alcoholic liver disease (ALD). At any stage of the disease, the Deritis ratio (AST/ALT) is more sensitive than other standard criteria in detecting biochemical abnormalities in ALD. This study's objective was to evaluate the importance of transaminases and the Deritis ratio as well as their potential prognostic value in alcoholic liver disease patients. Materials and Methods: It was a hospital-based retrospective study that used information kept in the Biochemistry department of Sri Venkateswara Medical College in Tirupati. Age, gender, total protein, albumin, AST, ALT, and AST/ALT ratio were the factors that was gathered. Descriptive statistics and hypothesis testing was analysed. Software tools EPI INFO and SPSS 23 was used to examine the data. Results: The percentage of ALD among the 50 patients was projected with 50 controls. Odds Ratio=3.2, p=0.0001, was 3.2 times more likely to develop above 40yrs of age. In ALD patients, the mean AST value (171.5 SD 94.46 IU/L) was substantially higher than the ALT value (85.12 SD 58.24 IU/L), resulting in a higher AST/ALT ratio (2.01 SD 0.58). When comparing the Deritis ratio in controls and cases, mean values are 0.78 with CI (1.02, 1.06) and 2.01 with CI (1.49, 1.69) respectively which showed higher signicance(p=0.001) in cases. An AST:ALT ratio &gt;2 with CI (93.9%, 99.9%) was present in 96.9% of individuals with alcoholic liver disease. Each variable's mean value in cases was considerably higher than in controls (p 0.001). Conclusion: Due to its widespread use, ethanol consumption causes various liver illnesses, each of which is extremely serious. Equally crucial is to know its complication and to know its magnitude of impact. To grasp the extent of damage in alcoholic liver disease rationally, the assessment of the Deritis ratio is helpful.

De Ritis ratio and long-term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention.

The association of aspartate aminotransferase to alanine aminotransferase ratio (De Ritis ratio) with clinical outcomes in patients with chronic coronary syndromes (CCS) remains unclear. This study aims to assess the association of De Ritis ratio with adverse cardiovascular events in patients with CCS. The study included 5020 patients with CCS undergoing percutaneous coronary intervention. Patients were categorized into groups according to tertiles of the De Ritis ratio: tertile 1 (De Ritis ratio: <.75; n=1688 patients), tertile 2 (De Ritis ratio: .75-1.08; n=1666 patients) and tertile 3 (De Ritis ratio: >1.08; n=1666 patients). The primary endpoint was 3-year mortality. At 3 years, there were 384 deaths, 176 myocardial infarctions and 61 strokes. In groups with De Ritis in the 1st, 2nd and 3rd tertiles, deaths occurred in 5.0%, 7.5% and 14.5% of the patients, respectively (adjusted hazard ratio=1.09, 95% confidence interval [1.06-1.12], p < .001); myocardial infarctions occurred in 2.6%, 3.5% and 5.1% of the patients, respectively (p < .001); strokes occurred in 1.0%, 1.2% and 1.9% of the patients, respectively (p=.030); bleeding at 30 days (n=112) occurred in 1.4%, 1.6% and 3.7% of the patients, respectively (p < .001). The C-statistic of the Cox proportional hazards model for all-cause mortality with baseline data without the De Ritis ratio was .815 [.794-.836] and .818 [.797-.838] after the inclusion of the De Ritis ratio (delta C-statistic=.003; p=.005). In patients with CCS undergoing percutaneous coronary intervention, an elevated De Ritis ratio was associated with long-term major adverse cardiovascular events.

Theme: Hepatobiliary system

Theme: Hepatobiliary system

De Ritis ratio and cardiovascular disease: evidence and underlying mechanisms

De Ritis ratio and cardiovascular disease: evidence and underlying mechanisms

Establishment and validation of a preoperative nomogram model for predicting the risk of hepatocellular carcinoma with microvascular invasion

Objective: To establish and validate a nomogram model for predicting the risk of microvascular invasion(MVI) in hepatocellular carcinoma. Methods: The clinical data of 210 patients with hepatocellular carcinoma who underwent hepatectomy at Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Qingdao University from January 2013 to October 2021 were retrospectively analyzed. There were 169 males and 41 females, aged(M(IQR)) 57(12)years(range:30 to 80 years). The patients were divided into model group(the first 170 cases) and validation group(the last 40 cases) according to visit time. Based on the clinical data of the model group,rank-sum test and multivariate Logistic regression analysis were used to screen out the independent related factors of MVI. R software was used to establish a nomogram model to predict the preoperative MVI risk of hepatocellular carcinoma,and the validation group data were used for external validation. Results: Based on the modeling group data,the receiver operating characteristic curve was used to determine that cut-off value of DeRitis ratio,γ-glutamyltransferase(GGT) concentration,the inverse number of activated peripheral blood T cell ratio (-aPBTLR) and the maximum tumor diameter for predicting MVI, which was 0.95((area under curve, AUC)=0.634, 95%CI: 0.549 to 0.719), 38.2 U/L(AUC=0.604, 95%CI: 0.518 to 0.689),-6.05%(AUC=0.660, 95%CI: 0.578 to 0.742),4 cm(AUC=0.618, 95%CI: 0.533 to 0.703), respectively. Univariate and multivariate Logistic regression analysis showed that DeRitis≥0.95,GGT concentration ≥38.2 U/L,-aPBTLR>-6.05% and the maximum tumor diameter ≥4 cm were independent related factors for MVI in hepatocellular carcinoma patients(all P<0.05). The nomogram prediction model based on the above four factors established by R software has good prediction efficiency. The C-index was 0.758 and 0.751 in the model group and the validation group,respectively. Decision curve analysis and clinical impact curve showed that the nomogram model had good clinical benefits. Conclusions: DeRitis ratio,serum GGT concentration,-aPBTLR and the maximum tumor diameter are valuable factors for preoperative prediction of hepatocellular carcinoma with MVI. A relatively reliable nomogram prediction model could be established on them.

Evaluation of Liver Function Tests (LFT) and C-reactive protein in COVID-19 (SARS Cov-2) positive patients diagnosed by Real-time PCR

Background/Aim: Unpredicted social and economic consequences have resulted from the SARS-CoV-2 pandemic worldwide. Limited information is currently available addressing the COVID-19 infection impact on the RT-PCR Cycle threshold value trend, infection risk factors, impact on liver enzymes, etc. Methods: From November 2020 to March 2021, a cross-sectional study was carried out in the Chemical Pathology also Molecular Biology divisions of the Pathology Department of Shalamar Hospital, Lahore. Results: Males had a higher risk of contracting SARS-CoV-2 infection than females about 51%. 36.5 percent of total infected people fell within the 20–40 age range. Significant factors that affect the severity of COVID-19 include age and underlying comorbidities. The majority of the patients (78.3%) reported fever, 50.4% had a cough, and 50.1% had myalgias. Low Ct value of RT-PCR may be asignificant predictor of illness severity and risk of mortality, with p values of 0.001 and 0.003, correspondingly. Disease severity was substantially associated with CRP, AST, ALT, and bilirubin indirect. It was observed that the Deritis ratio and CRP were highly associated with the risk of mortality. These markers can therefore be used to evaluate a patient's status as it progresses toward a severe disease, liver damage from treatment, and death risk. Conclusions: For doctors making patient management decisions, real-time PCR data and Ct values for SARS-CoV-2 may be useful. Age and comorbidities, among other risk variables, have been recognized as being associated with the likelihood of having a fatal illness. ALT, AST, Deritis ratio, and CRP are biochemical laboratory indicators that can be considered prognostic biomarkers for the development of severe disease and risk of mortality. Keywords: SARS-CoV-2, COVID-19, Liver, Cough, Pandemic

Assessment of Hepatobiliary Status and Cardiometabolic Risk Markers among Type 2 Diabetes Mellitus Patients. A Cross-Sectional Study

Objective: Previous studies have shown a higher prevalence of non-alcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM), and NAFLD itself is a risk factor for cardiovascular diseases (CVD). With both NAFLD and T2DM, there is a vicious circle of disease worsening, with one disease aggravating the development and progression of the other, thereby predisposing to early CVD events. Hence, we aimed to study the association between hepatobiliary status and cardiometabolic risk among T2DM patients. Material and methods: Eighty two patients with T2DM without any established liver and cardiac disease were recruited for the study. Routine biochemical parameters were measured by an autoanalyzer. Parameters such as triglyceride glucose index (TyG index), lipid pentad index, fatty liver disease index (FLDI) etc. were calculated using the established formulas. HbA1c was estimated using Biorad D10 autoanalyzer. Apolipoprotein B (Apo-B), Apo-A, lipoprotein (a) [Lp(a)], insulin, C-peptide were analyzed using ELISA. Results: Significant positive correlation was seen between cardiometabolic risk biomarkers and hepatobiliary biomarkers and significant negative correlation with total bilirubin and De-Ritis ratio. Through stepwise regression, FLDI was found to be a significant factor in the prediction of lipid pentad index (LPI). LPI, TyG index, FLDI were able to differentiate patients with T2DM based on the gold standard HbA1c values for T2DM diagnosis. Conclusions: Increase in hepatobiliary dysfunction contributes to increased CVD risk in T2DM patients. This study highlights the need for collaborative actions of diabetologists and hepatologists in identifying the people with NAFLD among T2DM patients, who should be targeted with intensive therapy to decrease their risk of future CVD events.