The AST/ALT (De Ritis) Ratio Independently Predicts Adverse Outcomes in Patients with Pyogenic Liver Abscess

Abstract

Background: An elevated aspartate aminotransaminase to alanine aminotransaminase ratio (AST/ALT) displays relationships to poor prognosis in viral hepatitis. However, the association between AST/ALT and pyogenic liver abscess (PLA) is unclear.Aim:This study delved into the relationships of AST/ALT and unfavorable results of PLA cases and ascertained AST/ALT predicting significance.Methods: In total, 240 PLA cases were consecutively recruited here and underwent a 3-month following-up. This study carried out receiver-operating characteristic (ROC) curve study, multiple-variate logistic regression analyses and univariate analysis.Results: In line with the receiver-operating curve of AST/ALT for unfavorable results, the cases fell to two subgroups with the use of a threshold of 0.97. Cases with high AST/ALT had higher risk of mortality (16.5% vs 2.9%), metastatic infection (19.1% vs 9.7%), acute hepatic failure (7.3% vs 2.2%), acute myocardial (7.3% vs 0.7%), empyema (23.7% vs 10.4%) and septic shock (13.7% vs 4.4%) than cases with low AST/ALT (all P < 0.05). after adjusting for potential confounders in our logistic model, high AST/ALT was independently associated with all unfavorable results (OR = 4.03, 95% CI = 2.12–7.66) and death (odds ratio (OR) = 6.17, 95% of confidence interval (CI) = 1.88–20.26). AST/ALT exhibited the widest area underneath ROC curve (AUC) as compared with AST, ALT in death prediction (AUC = 0.821, cutoff value = 1.31, P < 0.01) and overall unfavorable results (AUC = 0.690, cutoff value = 0.97, P < 0.01).Conclusion: AST/ALT may be a good candidate for predicting prognosis in future clinical practice of PLA.