De Ritis Research Articles

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

Cytokine imbalance and progression of changes in the liver parenchyma in patients with non-alcoholic fatty liver disease and essential hypertension

Objective — to determine the relationship between the activity of pro‑ and anti‑inflammatory cytokines and liver functional parameters in patients with non‑alcoholic fatty liver disease (NAFLD) and hypertension (HTN), depending on the degree of liver parenchyma damage. Materials and methods. The study included 120 people, divided into 3 groups: 49 patients (67.3% women) with NAFLD and concomitant HTN (main group); 51 patients (58.5% women) with isolated NAFLD (comparison group) and 20 relatively healthy individuals (55.0% women and 45.0% men) of the control group. In the main group, 55.1% of patients had steatosis, 44.9% had steatohepatitis. In the comparison group, 58.8% had steatosis, 41.2% had steatohepatitis (χ2=0.141, p=0.707). The assessments included body mass index (BMI), levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), γ‑glutamine transpeptidase, interleukin 8 and 10 (IL‑8, IL‑10), alkaline phosphatase (ALP), De Ritis index (AST/ALT ratio). The diagnosis of NAFLD and HTN was established in accordance with the local and international recommendations. Ultrasound examination of the liver was performed according to the standard method in fasting condition. Results. Body mass index corresponded to the normal or increased body weight: in the main group — 27.8 [26.6; 28.5] kg/m2 and 27.3 [24.2; 28.3] kg/m2 in the comparison group, in the control group — 24.3 [21.9; 26.0] kg/m2 (p&lt;0.001 and p=0.004 respectively). The results of the biochemical analysis showed a significant (p&lt;0.001) predominance of AST and ALT in patients with steatohepatitis compared to patients with steatosis, both in the main/group (AST=56.5 [54.0, 57.0] U/l and ALT=47.0 [44.5; 49.0] U/L, respectively), and in the comparison group (AST=45.0 [43.0; 48.0] U/l and ALT 39.0 [35.0; 42.0] U/L, respectively). The analysis of correlational relationships in patients with steatohepatitis, stronger relationships were found, both between the systemic increase in blood pressure, and between the cytokine’s levels and liver functional parameters. Thus, in patients of the main group with steatohepatitis, an inverse relationship was determined between the levels of AST and anti‑inflammatory IL‑10 (r=–0.588, p=0.004), the levels of GGTP (r=–0.407 p=0.060) and the levels of albumin (r=– 0.466, p=0.069). In patients of the comparison group and steatohepatitis, an inverse correlation was determined between the levels of diastolic blood pressure and GGTP (r=0.490, p=0.024). GGTP levels were also inversely correlated with AST levels (r=–0.508, p=0.019) and directly with IL‑8 and IL‑10 levels (r=0.438, p=0.049 and r=0.373, p=0.096). IL 10 demonstrated a strong negative correlation with albumin levels (r=–0.604, p=0.004). IL‑8 levels showed a direct correlation with IL‑10 (r=0.431, p=0.051) in this subgroup of patients. Conclusions. The presence of concomitant hypertension in patients with NAFLD was associated with more active progression compared to patients with isolated NAFLD. Correlation analysis showed gradual exhaustion of anti‑inflammatory protection and increase of pro‑inflammatory activity as changes in liver parenchyma progressed, especially in patients with comorbid NAFLD and HTN course. That allows us to consider HTN as a prognostically unfavorable risk factor for the development and progression of the liver parenchyma fibrosis.

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.

Factors associated with pathological tumor stage and T3a upstage in clinical T1-2 renal cell carcinoma.

Considering the oncological outcomes, understanding the preoperative factors associated with and predicting advanced stage and T3a upstage will help in risk assessment and selection of the right treatment. Patients with postoperative pathology of Renal Cell Carcinoma (RCC) and stage T1-2 N0M0 were included in the study. Demographic and pathological characteristics of the patients, Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis- the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were recorded. Patients were classified according to T stage (T1-2 vs T3-4) and T3a upstage (T3a upstaged vs non-T3a upstaged). A total of 289 patients participated in the study when inclusion and exclusion criteria were applied. No difference was found between the groups in terms of age, gender, body mass index, laterality, ABO blood group, Rh positivity and comorbidities. According to multivariate analysis, PLR, AST/ALT, Fuhrman grade, open radical nephrectomy (RN) and Clear Cell pathological subtype were found to be significant-independent factors in predicting advanced stage (T3-4) and T3a upstage (P<0.05). It was found that higher PLR and AST/ALT ratios were associated with more advanced stage and postoperative T3a upstage in RCC patients. In addition, these patients more frequently had open RN and had higher Fuhrman grades, while the clear cell subtype was less common.

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.

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

Cytokine-dependent mechanisms of the immune response implementation in patients with non-alcoholic fatty liver disease and arterial hypertension

The relevance of studying clinical and laboratory manifestations and liver inflammatory activity in patients with non‑alcoholic fatty liver disease (NAFLD) and arterial hypertension (HTN) is high, as it determines the aspects of preliminary diagnosis in patients from risk groups and allows to adjust of the diagnostic and therapeutic tactics of managing these patients. Objective — to study the ways of cytokine‑determined immune reactions implementation in patients with NAFLD and concomitant HTN. Materials and methods. The study involved 120 patients with NAFLD, from them 49 patients (67.3 % women and 32.7 % men) had concomitant HTN (the main group); 51 patients (58.5 % women and 41.2 % men) had isolated NAFLD (comparison group). The control group consisted of 20 relatively healthy subjects (55.0 % women and 45.0 % men). Body mass index (BMI) was calculated, and several biochemical indices were evaluated. The standard kinetic method was used to define levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The enzymatic colorimetric method was used to measure γ‑glutamylpeptidase levels, and levels of alkaline phosphatase, total protein and albumin were measured with colorimetric method. The de Ritis index was calculated. The interleukins 8 and 10 levels were determined using the immunofluorescence method with ElabScience (USA) reagents. Ultrasound examination of the liver was performed according to the standard method on an empty stomach using the device Samsung (Medison) SonoAce X8 (South Korea). To compare the data in the study groups, the liver oblique‑vertical dimension (CVD) was used. Results. The BMI increase was determined in both groups: with NAFLD and concomitant HTN and with isolated course (respectively 27.8 [26.6; 28.5] and 27.3 [24.2; 28.3] kg/ m2) compared to the control group (24.3 [21.9; 26.0] kg/ m2, p &lt; 0.001 and р = 0.004). The presence of concomitant HTN in patients with NAFLD was associated with the significant (p &lt; 0.001) deviations in the functional liver state, which was manifested by the prevalence of ALT levels (45 [43.0; 47.5] U/ L), AST levels (53 [51.0; 56.0] U/ L), alkaline phosphatase levels (285.7 [217.6; 321.1] U/ L) and gamma‑glutamine transpeptidase levels (96.2 [75.0; 108.9] U/ L) in comparison with the isolated NAFLD levels (respectively 36 [34.0; 39.0] U/ L, 41 [40.0; 45.0] U/ L, 215.5 [183.2; 246.7] U/ L and 65.5 [51.5; 76.8] U/ L) and control group levels (respectively 25.5 [24.0; 30.8] U/ L, 23 [19.3; 26.0] U/ L, 129.2 [116.9; 140.6] U/ L and 22.6 [16.1; 31.7] U/ L). A significantly (p &lt; 0.001) higher de Ritis index was determined in the main (1.16 [1.11; 1.24]) and comparison groups (1.14 [1.08; 1.21]) as compared to the control group (0.87 [0.76; 0.99]). Such changes in the liver functional activity correlated with the changes in cytokine‑determined immune reactions, which were manifested by a significant (p &lt; 0.001) predominance of interleukin‑8 and interleukin‑10 levels in patients with NAFLD and HTN (respectively, 29.4 [25.6; 34.9] and 20.3 [17.1; 24.4] pg/ mL) and isolated NAFLD (22.5 [19.1; 25.8] and 12.1 [10.5; 13.7] pg/ mL) compared to the control group (7.4 [6.7; 8.9] and 3.6 [2.8; 5.0] pg/ mL). Conclusions. The course of NAFLD is associated with the development of cytokine imbalance. A systematic increase in blood pressure can lead to an increase of cytokine‑mediated immune reactions activity in patients with NAFLD and concomitant HTN.

A nomogram for predicting the HER2 status of circulating tumor cells and survival analysis in HER2-negative breast cancer.

In breast cancer patients with HER2-negative tumors (tHER2-), HER2-positive CTCs (cHER2+) were associated with promising efficacy of HER2-targeted therapy, but controversy has persisted over its prognostic effect. We developed a model including clinicopathologic parameters/blood test variables to predict cHER2 status and evaluated the prognostic value of cHER2+ in tHER2- patients. cHER2+ was detected, blood test results and clinicopathological characteristics were combined, and a nomogram was constructed to predict cHER2 status in tHER2- patients according to logistic regression analysis. The nomogram was evaluated by C-index values and calibration curve. Kaplan-Meier curves, log-rank tests, and Cox regression analyses were performed to evaluate the prognostic value of cHER2 status. TNM stage, white blood cells (WBCs), neutrophils (NEUs), uric acid (UA), De Ritis ratio [aspartate transaminase (AST)/alanine transaminase (ALT)], and high-density lipoprotein (HDL) were found to be associated with cHER2 status in tHER2- patients in univariate logistic regression analysis, in which UA and De Ritis ratio remained significant in multivariate logistic regression analysis. A model combining these six variables was constructed, the C-index was 0.745 (95% CI: 0.630-0.860), and the calibration curve presented a perfect predictive consistency. In survival analysis, patients of the subgroups "with cHER2+/UA-low" (p = 0.015) and "with cHER2+/De Ritis ratio - high" (p = 0.006) had a significantly decreased disease-free survival (DFS). Our nomogram, based on TNM stage, WBC, NEU, UA, De Ritis ratio, and HDL, may excellently predict the cHER2 status of tHER2- patients. Incorporation with UA and De Ritis ratio may enhance the prognostic value of cHER2 status.

Performance of Derived Laboratory Biomarkers with Regard to 30-Day Mortality in Kidney Transplant Recipients with COVID-19.

There are limited data on the performance of laboratory-derived biomarkers in kidney transplant recipients (KTR) with COVID-19. This observational study enrolled 65 KTR with COVID-19 who were treated at the University Hospital of Split up to March 2022. Laboratory-derived biomarkers (neutrophile-to-lymphocyte (NLR) ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, De Ritis ratio, C-reactive protein (CRP)-to-albumin ratio, lactate dehydrogenase (LDH)-to-hemoglobin ratio, CRP-to-lymphocyte ratio, red cell distribution width-to-albumin ratio, platelet-to-albumin ratio, D-Dimer-to-albumin ratio, D-Dimer-to-NLR ratio, LDH-to-albumin ratio, and LDH-to-white blood cell (WBC) ratio) were calculated, and their performance with regard to 30-day mortality was determined. Mortality events occurred in 12 patients (18.5%), which was significantly associated with increased De Ritis (HR 3.83, 95% CI 1.57-9.35, p = 0.003), CRP-to-albumin (HR 1.36, 95% CI 1.13-1.64, p = 0.001), LDH-to-hemoglobin (HR 1.44, 95% CI 1.07-1.92, p = 0.015), CRP-to-lymphocyte (HR 1.03, 95% CI 1.01-1.07, p = 0.003), D-dimer-to-albumin (HR 4.94, 95% CI 1.38-7.24, p = 0.038), LDH-to-albumin (HR 1.20, 95% CI 1.05-1.36, p = 0.008), and LDH-to-WBC (HR 1.03 95% CI 1.01-1.05, p = 0.024) ratios. Out of these, the best area-under-the-curve (AUC) values were achieved with De Ritis (AUC 0.691), CRP-to-albumin (AUC 0.764), LDH-to-hemoglobin (AUC 0.877), CRP-to-lymphocyte (AUC 0.739), and LDH-to-albumin (AUC 0.827) ratios, while the best discrimination displayed LDH-to-hemoglobin ratio (Harrell's C 0.808 and Somers' D 0.616). The overall calibration was satisfactory for all models. Derived laboratory biomarkers such as the de Ritis, CRP-to-albumin, LDH-to-hemoglobin, CRP-to-lymphocyte, and LDH-to-albumin ratios show significant association and discrimination with all-cause mortality in KTR with COVID-19, suggesting its potential risk stratification role.

Impact of the De Ritis Ratio on the Prognosis of Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention.

BACKGROUND The aim of this study was to emphasize the impact of the aspartate aminotransferase-to-alanine aminotransferase ratio (De Ritis ratio) on the prognosis of patients with stable coronary artery disease (SCAD) undergoing percutaneous coronary intervention (PCI). MATERIAL AND METHODS Patients with SCAD who underwent elective PCI at Shinonoi General Hospital were included. SCAD was defined as epicardial coronary artery diameter stenosis ≥90% or epicardial coronary artery diameter stenosis ≥75% accompanied by symptoms or stress-induced myocardial ischemia. Clinical data were collected, and cardiovascular events were followed after discharge. One-way Cox proportional risk analysis was performed to assess the risk stratification value of the De Ritis ratio, using major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality as the primary and secondary endpoints, respectively. The independent risk stratification value was evaluated by multivariate Cox proportional risk analysis. RESULTS Among 204 patients with SCAD undergoing PCI, during a median follow-up period of 706 days (24 months), 13.7% (28/204) patients experienced MACCE, and 8.8% (18/204) experienced all-cause mortality. Multifactorial Cox regression analysis revealed that a high De Ritis ratio was an independent risk factor for MACCE (HR=2.96, 95% CI: 1.29-6.78, P=0.01) and all-cause mortality (HR=3.61, 95% Cl: 1.31-9.86, P=0.012). The sensitivity analysis further confirmed the incremental value of the De Ritis ratio for adverse cardiovascular events. CONCLUSIONS A high De Ritis ratio was an independent and valuable risk stratification factor for MACCE and all-cause mortality in patients with SCAD after PCI.

Evaluation of De Ritis (AST/ALT), ALP/ALT, and AST/ALP ratios as prognostic factors in patients with acute ischemic stroke

BackgroundStroke is one of the leading causes of disability worldwide. Recently, stroke prognosis estimation has received much attention. This study investigates the prognostic role of aspartate transaminase/alanine transaminase (De Ritis, AAR), alkaline phosphatase/alanine transaminase (ALP/ALT), and aspartate transaminase/alkaline phosphatase (AST/ALP) ratios in acute ischemic stroke (AIS).MethodsThis retrospective cohort study involved patients who experienced their first-ever AIS between September 2019 and June 2021. Clinical and laboratory data were collected within the first 24 hours after admission. Functional and mortality outcomes were evaluated 90 days after hospital discharge in clinical follow-up. Functional outcome was assessed by a modified Rankin Scale (mRS). The correlation between the laboratory data and study outcomes was evaluated using univariate analysis. In addition, regression models were developed to evaluate the predictive role of AST/ALP, ALP/ALT, and AAR ratios on the study outcomes.ResultsTwo hundred seventy-seven patients (mean age 69.10 ± 13.55, 53.1% female) were included. According to univariate analysis, there was a weak association between 3-months mRS, and both AST/ALT (r = 0.222, P < 0.001), and AST/ALP (r = 0.164, P = 0.008). Subsequently, higher levels of these ratios and absolute values of AST, ALT, and ALP were reported in deceased patients. Based on regression models adjusted with co-variable (age, gender, underlying disease, and history of smoking) AST/ALT and AST/ALP ratios had a significant independent association with 3-month mRS (CI:1.37-4.52, p = 0.003, and CI: 4.45-11,547.32, p = 0.007, respectively) and mortality (CI: 0.17-1.06, adjusted R2 = 0.21, p = 0.007, and CI: 0.10-2.91, p = 0.035, adjusted R2 = 0.20, respectively).ConclusionsElevated AST/ALP and AAR ratios at admission were correlated with poorer outcomes at 3 months in patients with first-ever AIS. Prospective studies in larger cohorts are required to confirm our findings and to evaluate further whether the AST/ALP and De Ritis ratios may represent a useful tool for determining the prognosis of AIS patients.

Value of de Ritis ratio in patients with liver steatosis

Value of de Ritis ratio in patients with liver steatosis

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

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.

PP001 De ritis ratio as a novel prognostic biomarker in atypical meningiomas: An Asian multi-institutional analysis

PP001 De ritis ratio as a novel prognostic biomarker in atypical meningiomas: An Asian multi-institutional analysis