Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China; Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai 200433, People's Republic of China; Department of Burns and Plastic Surgery, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan 430070, People's Republic of China.
Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China; Department of Critical Care Medicine, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, People's Republic of China.
Burns. 2022 Jun;48(4):872-879. doi: 10.1016/j.burns.2021.08.006. Epub 2021 Aug 18.
Although treatment of burn patients has significantly improved in recent decades, major burns remain fatal. Therefore, the evaluation of the death risk of the patients with extensive burns is very important. The ratio between the serum levels of aspartate transaminase and alanine transaminase (De Ritis ratio) was an independent predictor of poor outcomes in patients with acute ischemic stroke, cardiac surgery, non-metastatic renal cell carcinoma, and upper urinary tract urothelial carcinoma. Our aim was to determine whether the ratio between the serum levels of AST and ALT (De Ritis ratio) was useful to assess prognosis in extensively burned patients.
We conducted a single-center cohort study at the Burns Department of Changhai Hospital. This retrospective observational analysis was performed based on the clinical data of major burn patients admitted between May 1, 2005 and April 30, 2018. Univariate and multivariate logistic regression analyses were performed on variables such as age, sex, total body surface area (TBSA), De Ritis ratio, and serum albumin level, which may affect mortality in major burn patients. We assessed their diagnostic value and found the cut-off value by receiver operative characteristic (ROC) curve analysis. We used the Kaplan-Meier curve to display the impact of the De Ritis ratio and serum albumin level on survival in burn patients.
A total of 351 patients with extensive burns were included in the study. The cohort predominantly consisted of males (74.64%), and most of the patients (78.35%) had been burned by a flame. Age, TBSA, inhalation, and the De Ritis ratio were found to be independent risk factors for the 30-days mortality of major burn patients, while age, TBSA, inhalation, and the De Ritis ratio were independent risk factors for 90-day mortality. Further, the De Ritis ratio was a better mortality predictor than serum albumin in severely burned patients, whose area under ROC for 30-day and 90-day mortality was 0.771 (95% confidence intervals [CI], 0.708-0.835) and 0.750 (95% CI, 0.683, 0.818).
The De Ritis ratio was useful as a prognostic indicator for major burn patients, which can be conveniently obtained through blood examination. Regardless of whether the prediction was for 30-day or 90-day mortality, the accuracy remained high. Moreover, compared to serum albumin level, the De Ritis ratio was superior in assessing the prognosis of extensively burned patients.
尽管近几十年来烧伤患者的治疗有了显著改善，但大面积烧伤仍然是致命的。因此，评估大面积烧伤患者的死亡风险非常重要。天门冬氨酸转氨酶与丙氨酸转氨酶比值（De Ritis 比值）是急性缺血性脑卒中、心脏手术、非转移性肾细胞癌和上尿路尿路上皮癌患者不良预后的独立预测因素。我们的目的是确定血清天门冬氨酸转氨酶与丙氨酸转氨酶比值（De Ritis 比值）是否有助于评估大面积烧伤患者的预后。
我们在长海医院烧伤科进行了一项单中心队列研究。本回顾性观察性分析基于 2005 年 5 月 1 日至 2018 年 4 月 30 日期间入院的大面积烧伤患者的临床数据。对年龄、性别、体表面积（TBSA）、De Ritis 比值和血清白蛋白水平等可能影响大面积烧伤患者死亡率的变量进行单因素和多因素 logistic 回归分析。我们通过受试者工作特征（ROC）曲线分析评估了它们的诊断价值，并确定了截断值。我们使用 Kaplan-Meier 曲线显示 De Ritis 比值和血清白蛋白水平对烧伤患者生存的影响。
共有 351 例大面积烧伤患者纳入本研究。该队列主要由男性（74.64%）组成，大多数患者（78.35%）是火焰烧伤。年龄、TBSA、吸入和 De Ritis 比值是大面积烧伤患者 30 天死亡率的独立危险因素，而年龄、TBSA、吸入和 De Ritis 比值是 90 天死亡率的独立危险因素。此外，在严重烧伤患者中，De Ritis 比值是比血清白蛋白更好的死亡率预测指标，其 30 天和 90 天死亡率的 ROC 曲线下面积分别为 0.771（95%置信区间[CI]，0.708-0.835）和 0.750（95%CI，0.683，0.818）。
De Ritis 比值可作为大面积烧伤患者的预后指标，通过血液检查即可方便获得。无论预测的是 30 天还是 90 天死亡率，准确性都很高。此外，与血清白蛋白水平相比，De Ritis 比值在评估大面积烧伤患者的预后方面更具优势。
