Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
Eur J Clin Invest. 2021 Jan;51(1):e13427. doi: 10.1111/eci.13427. Epub 2020 Oct 25.
Increased concentrations of serum aspartate transaminase (AST) and alanine transaminase (ALT) are common in COVID-19 patients. However, their capacity to predict mortality, particularly the AST/ALT ratio, commonly referred to as the De Ritis ratio, is unknown. We investigated the association between the De Ritis ratio on admission and in-hospital mortality in 105 consecutive patients with coronavirus disease of 2019 (COVID-19) admitted to three COVID-19 referral centres in Sardinia, Italy. The De Ritis ratio was significantly lower in survivors than nonsurvivors (median: 1.25; IQR: 0.91-1.64 vs 1.67; IQR: 1.38-1.97, P = .002) whilst there were no significant between-group differences in ALT and AST concentrations. In ROC curve analysis, the AUC value of the De Ritis ratio was 0.701 (95% CI 0.603-0.787, P = .0006) with sensitivity and specificity of 74% and 70%, respectively. Kaplan-Meier survival curves showed a significant association between the De Ritis ratio and mortality (logrank test P = .014). By contrast, no associations were observed between the ALT and AST concentrations and mortality (logrank test P = .83 and P = .62, respectively). In multivariate Cox regression analysis, the HR in patients with De Ritis ratios ≥1.63 (upper tertile of this parameter) remained significant after adjusting for age, gender, smoking status, cardiovascular disease, intensity of care, diabetes, respiratory diseases, malignancies and kidney disease (HR: 2.46, 95% CI 1.05-5.73, P = .037). Therefore, the De Ritis ratio on admission was significantly associated with in-hospital mortality in COVID-19 patients. Larger studies are required to confirm the capacity of this parameter to independently predict mortality in this group.
血清天门冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）浓度升高在 COVID-19 患者中很常见。然而，其预测死亡率的能力，特别是通常被称为 De Ritis 比值的 AST/ALT 比值，尚不清楚。我们调查了意大利撒丁岛三个 COVID-19 转诊中心收治的 105 例连续 COVID-19 患者入院时和住院期间的 De Ritis 比值与死亡率之间的关系。与幸存者相比，非幸存者的 De Ritis 比值明显较低（中位数：1.25；IQR：0.91-1.64 与 1.67；IQR：1.38-1.97，P=0.002），而 ALT 和 AST 浓度在两组间无显著差异。在 ROC 曲线分析中，De Ritis 比值的 AUC 值为 0.701（95%CI 0.603-0.787，P=0.0006），灵敏度和特异性分别为 74%和 70%。Kaplan-Meier 生存曲线显示 De Ritis 比值与死亡率之间存在显著关联（对数秩检验 P=0.014）。相比之下，ALT 和 AST 浓度与死亡率之间无关联（对数秩检验 P=0.83 和 P=0.62）。在多变量 Cox 回归分析中，调整年龄、性别、吸烟状况、心血管疾病、护理强度、糖尿病、呼吸系统疾病、恶性肿瘤和肾脏疾病后，De Ritis 比值≥1.63（该参数的上三分位数）的患者的 HR 仍有统计学意义（HR：2.46，95%CI 1.05-5.73，P=0.037）。因此，入院时的 De Ritis 比值与 COVID-19 患者的住院死亡率显著相关。需要更大的研究来证实该参数独立预测该组死亡率的能力。
