Could the De Ritis ratio be a marker to predict the higher international normalized ratio values?

In the present study, we aimed to investigate the prognostic importance of the De Ritis ratio [Aspartate Aminotransferase (AST)/Alanine Aminotransferase (ALT)] in predicting higher international normalized ratio in patients on warfarin treatment.

Patients who were followed up for warfarin use at the Training and Research Hospital, between September 2023 and September 2024, were included in this study, consecutively and retrospectively.

The study included a total of 357 consecutive patients, who were divided into three groups according to INR values: Group 1: Those with INR below 2, Group 2: Those with INR between 2 and 3.5, Group 3: INR values above 3.5. The median ages of the patients were 62 years (range, 22 to 88), 61 years (range, 24 to 87), and 61 years (range, 40 to 87), respectively (p = 0.833). There were significant differences between the groups regarding lymphocyte values (median: 2.1 × 10³/µL vs 2.1 × 10³/µL vs 1.6 × 10³/µL, respectively) and De Ritis ratio (median 1.03 vs 1.15 vs 1.92) (p = 0.005, and p < 0.001, respectively).

We demonstrated a significant correlation between a high De Ritis ratio and high INR values. In light of this finding, a high De Ritis ratio may be indicative of elevated INR values for us.