Aspartate transaminase/alanine transaminase ratio as a significant prognostic factor in patients with sepsis: a retrospective analysis

Abstract Background: The study was performed to investigate the relationship between aspartate transaminase/alanine transaminase ratio (DRR) and long-term mortality among patients diagnosed with sepsis or septic shock. Methods: We conducted a retrospective study among adult septic patients who were admitted to surgical intensive care unit (ICU) of the Chinese People's Liberation Army (PLA) General Hospital from January 2014 to December 2018. Baseline characteristics were compared between survivors and non-survivors. We applied univariate as well as multivariate Cox regression analyses to evaluate DRR in relation to 180-day mortality. The potential prognostic value of DRR in predicting mortality rate was assessed by receiver operating curve (ROC) analysis. Besides, we conducted subgroup analysis by stratifying patients via optimal DRR cut-off value. Results: We included a total number of 183 patients in the current study, 44 (24%) patients died within 180-day hospitalization. Univariate and multivariate Cox analysis revealed that DRR was an independent predictor of 180-day mortality (hazard ratio [HR] 1.421, 95% confidence interval [CI] 1.073-1.883, P = 0.014). The predicting accuracy of 180-day mortality for DRR was presented as ROC with an area under the curve (AUC) of 0.708 (95% CI 0.629–0.786, P < 0.001). As we stratified all enrolled patients into two groups by using the optimal cut-off value of 1.29, we observed a significantly higher mortality in patients with relatively high DRR. Conclusions: An elevated DRR was associated with higher 180-day mortality among septic patients, and DRR might be an optimal marker for predicting the long-term mortality of sepsis. More prospective and randomized trials are needed to confirm the prognostic value of DRR.