AST/ALT ratio as a predictor of mortality and exacerbations of PM/DM-ILD in 1 year—a retrospective cohort study with 522 cases

Abstract

Objective To assess the associations between aspartate transaminase/alanine transaminase ratio (DRR) and mortality in patients with polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD). Patients and methods This was a retrospective cohort study, which included 522 patients with PM/DM-ILD whose DRR on admission were tested at West China Hospital of Sichuan University during the period from January 1, 2008, to December 31, 2018. Cox regression models were used to estimate hazard ratios for mortality in four predefined DRR strata (≤ 0.91, 0.91–1.26, 1.26–1.73, and > 1.73), after adjusting for age, sex, DRR stratum, diagnosis, overlap syndrome, hemoglobin, platelet count, white blood cell count, the percentage of neutrophils, neutrophil/lymphocyte ratio, albumin, creatine kinase, uric acid/creatinine ratio, triglycerides, or low-density lipoprotein. Results Higher DRR (> 1.73) was an independent predictor of 1-year mortality in multivariate Cox regression analysis (hazard ratio 3.423, 95% CI 1.481–7.911, p = .004). Patients with higher DRR more often required the use of mechanical ventilation and readmission for acute exacerbation of PM/DM-ILD at 1-year follow-up. Conclusion Higher DRR on admission for PM/DM-ILD patients are associated with increased mortality, risk of mechanical ventilation, and hospitalization in 1-year follow-up. This low-cost, easy-to-obtain, rapidly measured biomarker may be useful in the identification of high-risk PM/DM-ILD patients that could benefit from intensive management.

Elevated AST/ALT ratio is associated with all‐cause mortality and cancer incident

“…Li et al discovered that a higher AST/ALT ratio was an independent predictor of 1‐year mortality in polymyositis‐/dermatomyositis‐associated interstitial lung disease. 23 Likewise, a greater AST‐to‐ALT ratio at baseline was correlated with subsequent all‐cause mortality, especially cardiovascular diseases. 21 , 24 Cancer survival‐related studies have shown that a high AST/ALT ratio is associated with poor outcome of renal cell carcinoma, 13 head and neck carcinoma, 25 and oral and oropharyngeal carcinoma 26 among other cancers.…”

“…Recently, several studies demonstrated the association of the AST‐to‐ALT ratio with mortality. Li et al discovered that a higher AST/ALT ratio was an independent predictor of 1‐year mortality in polymyositis‐/dermatomyositis‐associated interstitial lung disease 23 . Likewise, a greater AST‐to‐ALT ratio at baseline was correlated with subsequent all‐cause mortality, especially cardiovascular diseases 21,24 .…”

The liver in COVID-19: prevalence, patterns, predictors, and impact on outcomes of liver test abnormalities

“…Put another way, a failure or inability to raise ALT as the disease progressed portended a worse outcome. Importantly, low ALT levels have been well-established as markers of frailty, especially in the elderly, and have been significantly associated with long-term mortality as well as worse short-term outcomes among a wide range of hospitalized patients [ 22 – 26 ]. Ours is the first cohort to suggest that this adverse prognostic value of low ALT may extend to hospitalized COVID-19 patients.…”

Resistin Expression Is Associated With Interstitial Lung Disease in Dermatomyositis

“…Previous results have shown that serum CRP, ferritin, IL-18, and LDH levels are related to DM-ILD, confirming this view ( 3 , 29 ). During ILD progression, macrophage activation can promote hepatocyte injury, resulting in increased ALT and AST levels ( 31 ). Previous data also showed that serum CEA and CA125 levels were closely related to DM-ILD ( 32 ).…”