Department of Cardiology, Osaka Medical College, Takatsuki, Japan.
Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Sci Rep. 2021 Jun 7;11(1):11957. doi: 10.1038/s41598-021-91368-z.
Frailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management. We hypothesized that the AST to ALT ratio (AAR) could be a marker of frailty in patients with heart failure. Data from the FRAGILE-HF study were analyzed. A total of 1327 patients aged ≥ 65 years hospitalized with heart failure were categorized into three groups based on their AAR at discharge: low AAR (AAR < 1.16, n = 434); middle AAR (1.16 ≤ AAR < 1.70, n = 487); high AAR (AAR ≥ 1.70, n = 406). The primary endpoint was one-year mortality. The association between AAR and physical function was also assessed. High AAR was associated with lower short physical performance battery and shorter 6-min walk distance, and these associations were independent of age and sex. Logistic regression analysis revealed that high AAR was an independent marker of physical frailty after adjustment for age, sex and body mass index. During follow-up, all-cause death occurred in 161 patients. After adjusting for confounding factors, high AAR was associated with all-cause death (low AAR vs. high AAR, hazard ratio: 1.57, 95% confidence interval, 1.02-2.42; P = 0.040). In conclusion, AAR is a marker of frailty and prognostic for all-cause mortality in older patients with heart failure.
衰弱是心力衰竭患者不良事件的常见合并症，早期识别是改善其管理的关键。我们假设天门冬氨酸氨基转移酶与丙氨酸氨基转移酶的比值（AAR）可能是心力衰竭患者衰弱的标志物。对 FRAGILE-HF 研究的数据进行了分析。共纳入 1327 名年龄≥65 岁的心力衰竭住院患者，根据出院时的 AAR 将其分为三组：低 AAR（AAR<1.16，n=434）；中 AAR（1.16≤AAR<1.70，n=487）；高 AAR（AAR≥1.70，n=406）。主要终点为一年死亡率。还评估了 AAR 与身体功能之间的关系。高 AAR 与短体适能电池和 6 分钟步行距离较短相关，这些关联独立于年龄和性别。Logistic 回归分析显示，在校正年龄、性别和体重指数后，高 AAR 是身体虚弱的独立标志物。在随访期间，共有 161 例患者发生全因死亡。在校正混杂因素后，高 AAR 与全因死亡相关（低 AAR 与高 AAR 相比，危险比：1.57，95%置信区间，1.02-2.42；P=0.040）。总之，AAR 是老年心力衰竭患者衰弱和全因死亡率的标志物。
