De Ritis Ratio to Predict Clinical Outcomes of Intermediate- and High-Risk Pulmonary Embolisms

Area of Science:

• Cardiology
• Hepatology
• Critical Care Medicine

Background:

• Abnormal liver function tests can indicate severe cardiopulmonary failure.
• The AST/ALT ratio (De Ritis ratio) assesses liver damage but its prognostic role in PE is unclear.
• Pulmonary embolism (PE) is a critical condition requiring accurate prognostic markers.

Purpose of the Study:

• To investigate the prognostic value of the baseline AST/ALT ratio in patients with intermediate- and high-risk PE.
• To determine if an abnormal AST/ALT ratio predicts mortality and other adverse outcomes in PE.
• To evaluate the association between AST/ALT ratio and key clinical markers in PE.

Main Methods:

• Retrospective analysis of two cohorts of intermediate- and high-risk PE patients.
• Stratification based on baseline AST/ALT ratio: abnormal (>1) versus normal (<1).
• Inverse probability weighted (IPW) analyses to assess the effect of abnormal AST/ALT ratios on outcomes, including 60-day mortality and peak NT-proBNP levels.

Main Results:

• Of 230 patients, 52 (23%) had an abnormal baseline AST/ALT ratio.
• IPW analysis revealed significantly higher 60-day mortality and peak NT-proBNP levels in patients with abnormal AST/ALT ratios.
• Abnormal AST/ALT ratios were associated with increased risks of shock, need for inotropes/vasopressors, mechanical ventilation, and extracorporeal life support.

Conclusions:

• The baseline AST/ALT ratio serves as a significant predictor of adverse outcomes in PE patients.
• An abnormal AST/ALT ratio is associated with increased risk of shock, multiorgan failure, and mortality in PE.
• The De Ritis ratio offers valuable prognostic information for managing patients with pulmonary embolism.