Inflammatory markers are being investigated as possible predictors of mortality in intensive care population. COVID-19 infection causes significant amount of inflammatory burden. De Ritis score has been suggested as a novel disease marker in conditions characterized with inflammation. In the present work, we aimed to compare De Ritis scores of deceased and survived COVID-19 patients in an institutional intensive care unit. Patients treated in intensive care unit with a diagnosis of COVID-19 infection were enrolled in the study. De Ritis scores of the deceased and survived subjects were compared. The De Ritis score among survivors and non-survivors was 1.12 (range: 0.3-6.9)% and 1.43 (range: 0.2-16)%, respectively, with a statistically significant difference (p = 0.03). Additionally, the De Ritis score exhibited significant positive correlations with lactate dehydrogenase (LDH) (r = 0.37, p < 0.001), D-dimer (r = 0.38, p < 0.001), and C-reactive protein (CRP) (r = 0.19, p = 0.01) levels. When the De Ritis score exceeded the 1.32% threshold, its sensitivity and specificity in predicting mortality were 60% and 61%, respectively, with an area under the curve (AUC) of 0.61 (p = 0.03, 95% confidence interval: 0.52-0.7). Furthermore, each unit increase in the De Ritis score was associated with a 96% increase in the odds of mortality among COVID-19 patients treated in the intensive care unit (p = 0.03, OR: 0.96, 95% confidence interval: 0.86-0.98). De Ritis score can be a useful marker of poor prognosis in COVID-19 patients in intensive care units.
References
1.
Lee H, Lee SE, Byun S, Kim HH, Kwak C, Hong SK. De Ritis ratio (aspartate transaminase/alanine transaminase ratio) as a significant prognostic factor after surgical treatment in patients with clear‐cell localized renal cell carcinoma: a propensity score‐matched study. BJU International. 2017;119(2):261–7.
2.
Lin Z, Long F, Yang Y, Chen X, Xu L, Yang M. Serum ferritin as an independent risk factor for severity in COVID-19 patients. Journal of Infection. 2020;81(4):647–79.
3.
Cheng L, Li H, Li L, Liu C, Yan S, Chen H, et al. Ferritin in the coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis. Journal of Clinical Laboratory Analysis. 2020;34(10).
4.
Li C, Ye J, Chen Q, Hu W, Wang L, Fan Y, et al. Elevated Lactate Dehydrogenase (LDH) level as an independent risk factor for the severity and mortality of COVID-19. Aging. 2020;12(15):15670–81.
5.
Fialek B, Pruc M, Smereka J, Jas R, Rahnama-Hezavah M, Denegri A, et al. Diagnostic value of lactate dehydrogenase in COVID-19: A systematic review and meta-analysis. Cardiology Journal. 29(5):751–8.
6.
Ikeagwulonu RC, Ugwu NI, Ezeonu CT. C-Reactive Protein and COVID-19 Severity: A Systematic Review. West Afr J Med. 2021;38(10):1011–23.
7.
Yitbarek GY, Walle Ayehu G, Asnakew S, Ayele FY, Bariso Gare M, Mulu AT, et al. The role of C-reactive protein in predicting the severity of COVID-19 disease: A systematic review. SAGE Open Medicine. 2021;9.
8.
Mosquera‐Sulbaran JA, Pedreañez A, Carrero Y, Callejas D. C‐reactive protein as an effector molecule in Covid‐19 pathogenesis. Reviews in Medical Virology. 2021;31(6).
9.
Mikami T, Miyashita H, Yamada T, Harrington M, Steinberg D, Dunn A, et al. Risk Factors for Mortality in Patients with COVID-19 in New York City. Journal of General Internal Medicine. 2021;36(1):17–26.
10.
Shi Q, Zhang X, Jiang F, Zhang X, Hu N, Bimu C, et al. Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study. Diabetes Care. 2020;43(7):1382–91.
11.
Noor FM, Islam MdM. Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis. Journal of Community Health. 2020;45(6):1270–82.
12.
Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Research and Clinical Practice. 2020;166:108293.
13.
Gao F, Chen C, Lu J, Zheng J, Ma XC, Yuan XY, et al. De Ritis ratio (AST/ALT) as an independent predictor of poor outcome in patients with acute ischemic stroke. Neuropsychiatric Disease and Treatment. Volume 13:1551–7.
14.
Zhao P yue, Yao R qi, Ren C, Li S yan, Li Y xuan, Zhu S yu, et al. De Ritis Ratio as a Significant Prognostic Factor in Patients with Sepsis: A Retrospective Analysis. Journal of Surgical Research. 2021;264:375–85.
15.
Eryilmaz-Eren E, Turunc-Ozdemir A, Kanat A, Ture Z, Kilinc-Toker A, Celik I. The Association of De Ritis Ratio with the Severity of Crimean–Congo Hemorrhagic Fever. Future Virology. 2023;18(9):575–82.
16.
Karagoz I, Aktas G, Yoldas H, Yildiz I, Ogun MN, Bilgi M, et al. Association Between Hemogram Parameters and Survival of Critically Ill Patients. Journal of Intensive Care Medicine. 2019;34(6):511–3.
17.
Kaushal K, Kaur H, Sarma P, Bhattacharyya A, Sharma DJ, Prajapat M, et al. Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis. Journal of Critical Care. 2022;67:172–81.
18.
Lu Z, Ma G, Chen L. De-Ritis Ratio Is Associated with Mortality after Cardiac Arrest. Disease Markers. 2020;2020:1–13.
19.
Pilarczyk K, Carstens H, Heckmann J, Canbay A, Koch A, Pizanis N, et al. The aspartate transaminase/alanine transaminase (DeRitis) ratio predicts mid-term mortality and renal and respiratory dysfunction after left ventricular assist device implantation. European Journal of Cardio-Thoracic Surgery. 2017;52(4):781–8.
20.
Duman TT, Erge E, Tel BMA, Kiziltunc C, Aktas G. De Ritis score as an inflammatory marker in Hashimoto’s thyroiditis. Precision Medical Sciences. 2023;12(4):242–6.
21.
De Ritis F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis: The transaminase serum activities. Clinica Chimica Acta. 2006;369(2):148–52.
22.
Atak Tel BM, Bilgin S, Kurtkulagi O, Kahveci G, Duman TT, Sagdic T, et al. Frailty in Diabetic Subjects during COVID-19 and Its Association with HbA1c, Mean Platelet Volume and Monocyte/Lymphocyte Ratio. Clinical Diabetology. 11(2):119–26.
23.
Atak Tel B, Kahveci G, Bilgin S, Kurtkulagi O, Taslamacioglu Duman T, Demirkol M, et al. Haemoglobin and red cell distribution width levels in internal medicine patients indicate recurrent hospital admission during COVID-19. Family Medicine & Primary Care Review. 2022;24(1):32–6.
24.
Khalid A, Ali Jaffar M, Khan T, Abbas Lail R, Ali S, Aktas G, et al. Hematological and biochemical parameters as diagnostic and prognostic markers in SARS-COV-2 infected patients of Pakistan: a retrospective comparative analysis. Hematology. 2021;26(1):529–42.
25.
Aktas G. Hematological predictors of novel Coronavirus infection. Revista da Associação Médica Brasileira. 67(suppl 1):1–2.
26.
Aktas G, Balci B, Yilmaz S, Bardak H, Duman TT. Characteristics of Covid-19 infection with the original SARS-Cov-2 virus and other variants: A comparative review. Journal of Bionic Memory.
27.
Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA. 2020;323(13):1239.
28.
Aktas G. A comprehensive review on rational and effective treatment strategies against an invisible enemy; SARS Cov-2 infection. Experimental Biomedical Research. 2020;3(4):293–311.
29.
Hu X, Liang J, Hao W, Zhou J, Gao Y, Gong X, et al. Prognostic value of inflammatory markers for in-hospital mortality in intensive care patients with acute ischemic stroke: a retrospective observational study based on MIMIC-IV. Frontiers in Neurology. 14.
30.
KARAGOZ I, OZER B, ITAL I, TURKOGLU M, DISIKIRIK A, OZER S. C-reactive protein-to-serum albumin ratio as a marker of prognosis in adult intensive care population. Bratislava Medical Journal.
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