Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China; Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China; Fujian Heart Failure Center Alliance, Fuzhou, China.
Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, China.
J Cardiol. 2022 May;79(5):618-625. doi: 10.1016/j.jjcc.2021.11.009. Epub 2021 Nov 29.
Pre-procedure liver insufficiency has been demonstrated as a poor prognostic factor after percutaneous coronary intervention (PCI). Recent research discovered that the aspartate aminotransferase-to-alanine aminotransferase ratio (De-Ritis ratio) reflects the severity of liver insufficiency and was associated with adverse outcomes. We aim to evaluate the predictive value of the De-Ritis ratio for contrast-associated acute kidney injury (CA-AKI) and long-term mortality in patients undergoing elective PCI.
We retrospectively enrolled 5780 consenting patients undergoing elective PCI between January 2012 and December 2018. CA-AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥50% within 48 h after the administration of contrast media.
The incidence of CA-AKI was 6.3% (n = 363). The De-Ritis ratio >1.30 was identified as the best cut-off value for CA-AKI prediction. The De-Ritis ratio showed an area under the curve (AUC) of 0.636 [95% confidence interval (CI): 0.605-0.667] in predicting CA-AKI, which was significantly greater than alanine aminotransferase (p<0.001) and aspartate aminotransferase (p = 0.012) alone. Furthermore, compared to currently recognized liver function assessment tools, the predictive value of the De-Ritis ratio on CA-AKI was similar to the MELD score (AUC: 0.636 vs 0.626, p = 0.631) and higher than the MELD-XI score (AUC: 0.636 vs 0.561, p<0.001). Multivariate logistic analysis showed that the De-Ritis ratio >1.30 was independently associated with CA-AKI (odds ratio=1.551, 95% CI: 1.185-2.030, p = 0.001). The addition of the De-Ritis ratio to the fully adjusted logistic regression model has significant incremental effects on the risk prediction for CA-AKI with a continuous net reclassification improvement of 0.395 (p<0.001) and an integrated discrimination improvement of 0.005 (p = 0.018). Additionally, the De-Ritis ratio >1.30 was significantly associated with long-term mortality (hazard ratio=1.285, 95% CI: 1.007-1.641, p = 0.044).
The De-Ritis ratio was an independent risk factor for CA-AKI and long-term mortality in patients undergoing elective PCI.
经皮冠状动脉介入治疗（PCI）后，术前肝功能不全已被证明是预后不良的一个因素。最近的研究发现，天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值（De-Ritis 比值）反映了肝功能不全的严重程度，并与不良结局相关。我们旨在评估 De-Ritis 比值对行择期 PCI 患者造影剂相关急性肾损伤（CA-AKI）和长期死亡率的预测价值。
我们回顾性纳入了 2012 年 1 月至 2018 年 12 月间行择期 PCI 的 5780 名患者。CA-AKI 定义为使用造影剂后 48 小时内血清肌酐升高≥0.3mg/dl 或≥50%。
CA-AKI 的发生率为 6.3%（n=363）。De-Ritis 比值>1.30 被确定为预测 CA-AKI 的最佳截断值。De-Ritis 比值预测 CA-AKI 的曲线下面积（AUC）为 0.636（95%CI：0.605-0.667），显著大于丙氨酸氨基转移酶（p<0.001）和天门冬氨酸氨基转移酶（p=0.012）单独预测的 AUC。此外，与目前公认的肝功能评估工具相比，De-Ritis 比值对 CA-AKI 的预测价值与 MELD 评分相似（AUC：0.636 与 0.626，p=0.631），高于 MELD-XI 评分（AUC：0.636 与 0.561，p<0.001）。多变量 logistic 分析显示，De-Ritis 比值>1.30 与 CA-AKI 独立相关（比值比=1.551，95%CI：1.185-2.030，p=0.001）。De-Ritis 比值加入完全调整的 logistic 回归模型后，对 CA-AKI 的风险预测具有显著的增量效应，连续净重新分类改善 0.395（p<0.001），综合判别改善 0.005（p=0.018）。此外，De-Ritis 比值>1.30 与长期死亡率显著相关（风险比=1.285，95%CI：1.007-1.641，p=0.044）。
De-Ritis 比值是行择期 PCI 患者发生 CA-AKI 和长期死亡率的独立危险因素。
