The Preoperative AST/ALT (De Ritis) Ratio Represents a Poor Prognostic Factor in a Cohort of Patients with Nonmetastatic Renal Cell Carcinoma

Bezan, Angelika; Mrsic, Edvin; Krieger, Daniel; Stojaković, Tatjana; Pummer, Karl; Zigeuner, Richard; Hutterer, Georg C.; Pichler, Martin

doi:10.1016/j.juro.2015.01.083

Cited by 120 publications

(147 citation statements)

References 28 publications

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“…The optimal cut-off value for the continuous AAR was calculated by applying a receiver operating curve analysis to test all possible cut-offs that would discriminate between CLI and non-CLI as previously described. [12] …”

Section: Methodsmentioning

confidence: 99%

The AST/ALT (De-Ritis) ratio

Rief

Pichler²,

Raggam

et al. 2016

Medicine

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The aspartat aminotransferase (AST)/alanin aminotransferase (ALT) (De-Ritis) ratio (AAR) is an easily applicable blood test. An elevated AAR on the one hand has been associated with an increase in nonalcoholic fatty liver disease (NAFLD). NAFLD on the other hand is associated with an increase in cardiovascular disease, all-cause mortality, and diabetes. As the AAR is also elevated in case of muscular damage, we investigated AAR and its association with critical limb ischemia (CLI) in peripheral arterial occlusive disease (PAOD) patients.In our cross-sectional study, we included 1782 PAOD patients treated at our institution from 2005 to 2010. Patients with chronic alcohol consumption (>20 g/day) were excluded. AAR was calculated and the cohort was categorized into tertiles according to the AAR. An optimal cut-off value for the continuous AAR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI.In our cohort, occurrence of CLI significantly increased with an elevation in AAR. As an optimal cut-off value, an AAR of 1.67 (sensitivity 34.1%, specificity 81.0%) was identified. Two groups were categorized, 1st group containing 1385 patients (AAR < 1.67) and a 2nd group with 397 patients (AAR > 1.67). CLI was more frequent in AAR > 1.67 patients (166 [41.9%]) compared to AAR < 1.67 patients (329 [23.8%]) (P < 0.001), as was prior myocardial infarction (28 [7.1%] vs 54 [3.9%], P = 0.01). Regarding inflammatory parameters, C-reactive protein (median 8.1 mg/L [2.9–28.23] vs median 4.3 mg/L [2.0–11.5]) and fibrinogen (median 427.5 mg/dL [344.25–530.0] vs 388.0 mg/dL [327.0–493.0]) also significantly differed in the 2 patient groups (both P < 0.001). Finally, an AAR > 1.67 was associated with an odds ratio (OR) of 2.0 (95% confidence interval [CI] 1.7–2.3) for CLI even after adjustment for other well-established vascular risk factors.An increased AAR is significantly associated with patients at high risk for CLI and other cardiovascular endpoints. The AAR is a broadly available and cheap marker, which might be useful to highlight patients at high risk for vascular endpoints.

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Section: Methodsmentioning

confidence: 99%

The AST/ALT (De-Ritis) ratio

Rief

Pichler²,

Raggam

et al. 2016

Medicine

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“…AAR was subsequently used to predict the presence of progressive fibrosis in chronic hepatic B patients and poor survival in chronic viral hepatitis C 24. In recent years, AAR has been shown to be a useful predictor for nonhepatic diseases and a prognostic biomarker in certain types of malignant tumor 11,14–16,24–27. For example, in a large European cohort of nonmetastatic renal cell carcinoma patients, Bezan et al identified preoperative AAR as a predictor of a poor clinical outcome 11.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, AAR has been shown to be a useful predictor for nonhepatic diseases and a prognostic biomarker in certain types of malignant tumor 11,14–16,24–27. For example, in a large European cohort of nonmetastatic renal cell carcinoma patients, Bezan et al identified preoperative AAR as a predictor of a poor clinical outcome 11. Nishikawa et al discovered that preoperative AAR was significantly correlated with a fourfold increase in an unfavorable prognosis in patients with upper urinary tract urothelial carcinoma 13.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have also described AST as being associated with the cerebral infarct size and hemorrhagic transformation after AIS 9,10. As a routine noninvasive laboratory test, the AST/ALT ratio (De Ritis ratio, AAR) represents the simultaneous alteration of AST and ALT levels, which has been used to assess the risk of critical limb ischemia in peripheral arterial occlusive disease and nonalcoholic fatty liver disease, and treated as a prognostic marker for diseases such as nonmetastatic renal cell carcinoma and upper urinary tract urothelial carcinoma 11–16…”

Section: Introductionmentioning

confidence: 99%

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De Ritis ratio (AST/ALT) as an independent predictor of poor outcome in patients with acute ischemic stroke

Gao¹,

Chen²,

Lu³

et al. 2017

NDT

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PurposeThe aspartate transaminase/alanine transaminase ratio (De Ritis ratio, AAR) was reported to be associated with patients’ prognosis in certain diseases recently. The objective of the current study was to determine the association between the AAR at admission and poor outcome at 3 months in acute ischemic stroke (AIS) patients.Patients and methodsThis retrospective cohort study included patients who experienced their first-ever AIS between June 2015 and March 2016. The primary outcome measure was a poor outcome at 3 months (modified Rankin Scale score >2). Multivariate logistic regression models were used to assess the relationship between AAR quartiles and clinical outcomes among the AIS patients. Receiver operating characteristic curve analysis was applied to identify the optimal cutoff for AAR in predicting the prognosis of AIS.ResultsIn terms of the relationship between poor outcome and AAR, the adjusted odds ratio comparing the highest and lowest AAR quartiles was 2.15 (95% confidence interval =1.14–4.05). An AAR of 1.53 was identified as the optimal cutoff. In a prespecified subgroup analysis according to the time from symptom onset to treatment (>24 vs ≤24 hours), there was no significant difference in the effect of AAR >1.53 between the two groups.ConclusionAn increased AAR at admission is significantly associated with a poor outcome at 3 months in AIS patients.

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“…The incidence of chronic renal failure has been rising, due to increasing prevalence of conditions such as diabetes or viral hepatitis, which can be associated with renal damage. In addition, AST and ALT levels, which provide the De Ritis ratio [24], have been previously reported as significant prognostic biomarkers in several malignancies including kidney diseases [25]. The mechanism underlying the relationship of AST and RCC is related to the vital role of AST in glycolysis by relocation of NADH into the mitochondria through the malate-aspartate shuttle pathway, in which clear cell RCC with VHL loss was known to induce the expression of hypoxia factors known to be connected to extensively increased glycolysis in the mitochondria, which is well-known as the Warburg effect [26, 27].…”

Section: Discussionmentioning

confidence: 99%

Baseline Chronic Kidney Disease and Ischemic Method of Partial Nephrectomy Are Important Factors for the Short- and Long-Term Deterioration in Renal Function for Renal Cell Carcinoma Staged T1-T2: A Retrospective Single Center Study

Kim

Joung

Seo

et al. 2016

BioMed Research International

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The renal functions of 215 patients (24 with benign renal mass, the rest with RCC staged T1-T2) who underwent partial nephrectomy (PN) between 2003 and 2014 were evaluated to identify predictors of short- and long-term deterioration in renal function after PN among renal cell carcinoma (RCC) patients with or without preoperative predisposition to chronic kidney disease (CKD) and among patients with benign renal mass. The 1- and 5-year predictive factors for de novo CKD were statistically analyzed. The incidence of de novo CKD differed significantly (p < 0.001) among patients with benign renal mass, those with RCC but no preoperative CKD predisposition, and those with RCC combined with preoperative CKD predisposition. Independent predictors for de novo CKD at 1 year postoperatively included intraoperative ischemic method, ECOG score, elevated albumin levels, male sex, and smoking exposure (in pack-years). Predictors for de novo CKD at 5 years postoperatively included hypertension, high preoperative albumin levels, De Ritis ratio (aspartate aminotransferase/alanine aminotransferase ratio), smoking exposure, and preoperative predisposition to CKD. Preoperative predisposition to CKD and ischemic method applied during PN, along with other preoperative parameters, were important factors affecting postoperative renal function deterioration in patients with T1-T2 RCC.

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The Preoperative AST/ALT (De Ritis) Ratio Represents a Poor Prognostic Factor in a Cohort of Patients with Nonmetastatic Renal Cell Carcinoma

Abstract: In our study cohort with nonmetastatic renal cell carcinoma the preoperatively assessed AST/ALT ratio represented an independent prognostic factor. This ratio might further improve the predictive accuracy of well established prognosis scores.

Cited by 120 publications

References 28 publications

The AST/ALT (De-Ritis) ratio

The AST/ALT (De-Ritis) ratio

De Ritis ratio (AST/ALT) as an independent predictor of poor outcome in patients with acute ischemic stroke

Baseline Chronic Kidney Disease and Ischemic Method of Partial Nephrectomy Are Important Factors for the Short- and Long-Term Deterioration in Renal Function for Renal Cell Carcinoma Staged T1-T2: A Retrospective Single Center Study

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