News: De Ritis ratio predicts mortality risk in sepsis-associated liver injury, research shows
Of the three risk stratification approaches used, the De Ritis ratio most effectively stratified the risk for 30-day mortality in patients with sepsis-associated liver injury (SALI), according to a study recently published in The Lancet. SALI patients were first assessed by the De Ritis ratio, the R-factor, and serum alanine aminotransferase (ALT) levels, after which researchers assessed the association between these stratification methods and a 30-day mortality risk.
Researchers analyzed data from two ICU databases, identifying SALI patients using Sepsis-3 criteria and liver injury markers, which resulted in 3,235 patients with SALI and 9,481 patients without it. SALI patients had nearly two times higher risk of 30-day mortality than those without SALI.
The study tested each stratification method and found all were successful in classifying patients, but the De Ritis ratio emerged as the strongest prognostic differentiation method in consistently identifying patients with a high risk for 30-day mortality across all admission types and sources of infection. The three methods are defined as follows:
- The De Ritis ratio: The ratio of serum aspartate aminotransferase (AST) to ALT levels, with a ratio greater than one significantly predicting an elevated risk and a ratio less than or equal to one showing no increase in the risk for mortality
- R-factor: The ratio of ALT levels divided by their upper limit of normal (ULN) to alkaline phosphatase levels divided by their ULN, with patients categorized as having R greater than two, greater than or equal to two, greater than five, and greater than or equal to five
- Alanine aminotransferase elevation: The ratio of ALT levels greater than two ULN, greater or equal to two and less than five ULN, and greater than or equal to five ULN
“This study identifies the De Ritis ratio as a robust tool for stratifying 30-day mortality risk in SALI,” the authors wrote. “The De Ritis ratio's simplicity and accessibility make it a proper candidate for straightforward clinical use, particularly in critical care settings where rapid, informed decision-making is essential.”
Editor’s note: To access The Lancet study’s findings, click here.