High Aspartate Aminotransferase to Alanine Aminotransferase Ratio on Admission as Risk Factor for Poor Prognosis in COVID-19 Patients

Abstract

This study aimed to analyze aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio in COVID-19 patients. After exclusion, 567 inpatients were included in this study and separated into two groups according to their AST/ALT ratio on admission. Poor prognosis included death and transfer to other hospitals due to deterioration. Of 567 patients, 56 (9.9%) had AST/ALT ≥ 2. Of the 56 patients, older age (median age 65.5 years), fatigue (29 [51.8%] cases), comorbidities (33 [58.9%] cases) and outcomes were significantly different from patients with AST/ALT < 2. They also had worse chest computed tomography (CT) findings, laboratory results and severity scores. Levels of platelet count (OR = 0.989, 95% CI [0.983-0.996]) were independently associated with AST/ALT ≥ 2 on admission. Furthermore, a high AST/ALT ratio on admission was an independent risk factor for poor prognosis (OR = 22.02, 95% CI [1.84-263.2]), especially in patients with AST levels > 40 U/L. In subsequent monitoring, the AST/ALT ratio was decreased in both patients with AST/ALT < 2 or ≥ 2 on admission. COVID-19 patients who are older, or have fatigue, comorbidities are more likely to have AST/ALT ≥ 2 on admission, which might be the indication of worse status and outcomes.

Role of inflammatory and liver function markers in assessing the prognosis of patients with COVID‑19

“…According to the study by Zinellu et al (39), the median De Ritis ratio was 1.33, similar to that reported by Yazar et al in their cohort (38). Furthermore, according to the study by Qin et al (41), the cut-off value of the De Ritis ratio was found to be 1.38; patients with a De Ritis ratio >1.38 upon admission have a significantly poor survival (41). With the hepatic proportion of the AST:ALT ratio of 2.5:1, the hepatocyte turnover may result in a much higher amount of AST in serum compared to ALT.…”

Clinical characteristics and predictors for in-hospital mortality in adult COVID-19 patients: A retrospective single center cohort study in Vilnius, Lithuania

“…Furthermore, our research demonstrated that AST to ALT ratio has better predictive accuracy for in-hospital mortality than AST or ALT separately, and patients with AST to ALT ratio >1.49 had 54% higher odds for lethal outcome. Consistent results were reported in other studies [60][61][62].…”

Myoglobin and C-reactive protein are efficient and reliable early predictors of COVID-19 associated mortality

“…The analysis of recently published studies reveals the role of systemic vasculitis and cytokine-mediated coagulation disorders, predominantly responsible for multi-organ failure in patients with severe COVID-19 complications. The hematological (lymphocyte count 11,12 , neutrophil count 13 , neutrophil-lymphocyte ratio (NLR)) 14,15 , inflammatory (C-reactive protein (CRP)) 16 , immunological (interleukin (IL)-6) 17 and biochemical (D-dimer 18 , troponin, creatine kinase (CK) 19 biomarkers, as well as procalcitonin (PCT) 16,20 , erythrocyte sedimentation rate (ESR) 21 , aspartate aminotransferase (AST)) 22 , and those particularly related to coagulation cascades in disseminated intravascular coagulation (DIC) 23 and acute respiratory distress syndrome (ARDS) 24 have been reported to be important biomarkers associated with COVID-19 disease. New laboratory biomarkers could be identified through the accurate analysis of multicentric case series; in particular, homocysteine and angiotensin II could play a significant role in this regard 24 .…”