Correlation between De Ritis Ratio with Severity of Covid-19 Patients Severity

Authors

  • Tiene Rostini Department of Clinical Pathology Dr Hasan Sadikin General Hospital Bandung
  • Khairunnissa Khairunnissa Resident of Clinical Pathology Faculty of Medicine Universitas Padjadjaran Bandung
  • Dewi Kartika Turbawaty Department of Clinical Pathology Dr. Hasan Sadikin General Hospital Bandung

Keywords:

ALT, AST, Covid-19, De Ritis ratio

Abstract

SARS COV-2 is the causative agent of the infectious disease Corona Virus Illness-19 (Covid-19). Covid-19 can cause damage to multiple organs, including the liver. The de Ritis ratio is a ratio between AST and ALT in blood serum, which may be a useful indicator for assessing liver damage in Covid-19 patients. The aim of this study is to determine the association between the severity of liver injury and an increase in the de Ritis ratio in Covid-19. The study population included patients with acute Covid-19 disease whose infection was validated using real-time PCR. A retrospective cross-sectional study was conducted.  There were 1.983 subjects included, and 1.123 belonged to the moderate, 673 severe, and 181 to the critical groups. Calculations using Spearman rank revealed a strong significant association between De Ritis ratio and Covid-19 grade severity (rs=0.624, p<0.001). The more severe Covid-19, the higher de Ritis ratio values. The ROC curve of de Ritis ratio with Covid-19 severity shows AUC of 0.771 (P<0.001), sensitivity of 63.5%, specificity of 90.6%, PPV of 98.5% and an NPV of 20.02%. In conclusion, the severity of Covid-19 symptoms increases proportionally with the de Ritis ratio.

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References

World Health Organization. WHO COVID-19 Dashboard. (Online). https://data.who.int/dashboards/covid19/cases?n=c [accessed 20 January 2022].

Infeksi Emerging. Situasi Terkini Perkembangan Coronavirus Disease (COVID-19) 25 November 2021. https://infeksiemerging.kemkes.go.id/situasi-infeksi-emerging/situasi-terkini-perkembangan-coronavirus-disease-covid-19-25-november-2021 [accessed 22 January 2022].

Wu Z and McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (Covid-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13): 1239-1242. doi:10.1001/jama.2020.2648

Pranata R, Huang I, Lim Ma, et al. Elevated De Ritis Ratio is Associated with Poor Prognosis in Covid-19: A Systematic Review and Meta-Analysis. Frontiers in Medicine. 2021; 8: 1-9.

Hayrullah Y, Kayacan Y, and Ozdin M. De Ritis Ratio and Biochemical Parameters in Covid-19 Patients. Archives of Physiology and Biochemistry. 2020; 128(6): 1676-1680.

Chen F, Chen W, Chen J, et al. Clinical Features and Risk Factors of Covid-19-Associated Liver Injury and Function: A Retrospective Analysis of 830 Cases. Annals of Hepatology. 2021; 21: 1-9.

Botros M and Sikaris KA. The De Ritis Ratio: The Test of Time. The Clinical Biochemist Reviews. 2013; 34(3): 117-130.

Zinellu A, Arru F, De Vito A, et al. The De Ritis Ratio as Prognostic Biomarker of in-Hospital Mortality in Covid-19 Patients. European Journal of Clinical Investigation. 2020; 51(1): 1-8.

Sharma A, Jaiswal P, Kerakhan Y, et al. Liver Disease and Outcomes among Covid-19 Hospitalized Patients - A Systematic Review and Meta-Analysis. Annals of Hepatology. 2021; 21: 1-8.

Moorthy S, Koshy T, Kumar MK, and Silambanan S. Role of Inflammatory and Liver Function Markers in Assessing the Prognosis of Patients with Covid‑19. World Academy of Science Journal. 2021; 3(6): 1-9.

El Ouali S, Romero-Marrero C, Regueiro M. Hepatic Manifestations of Covid-19. Cleveland Clinical Journal of Medicine. 2020; 87: 1-4.

Bertolini A, van de Peppel IP, Bodewes FAJA, et al. Abnormal Liver Function Tests in Patients with Covid-19: Relevance and Potential Pathogenesis. Hepatology. 2020; 72(5): 1864-1872.

Kementerian Kesehatan Republik Indonesia. Pedoman Pencegahan dan Pengendalian Coronavirus Disesase (Covid-19). Jakarta: Kemenkes RI; 2020.

Wasityastuti W, Dhamarjati A, and Siswanto S. Immunosenescence and the Susceptibility of the Elderly to Coronavirus Disease 2019 (Covid-19). Jurnal Respirologi Indonesia 2020; 40(3): 182-191.

Medetalibeyoglu A, Catma Y, Senkal N, et al. The Effect of Liver Test Abnormalities on the Prognosis of Covid-19. Annals of Hepatology. 2020; 19(6): 614-621.

Drácz B, Czompa D, Müllner K, et al. The Elevated De Ritis Ratio on Admission is Independently Associated with Mortality in Covid-19 Patients. Viruses. 2022; 14(11): 1-19.

Zhang X, Yu Y, Zhang C, et al. Mechanism of SARS-CoV-2 Invasion into the Liver and Hepatic Injury in Patients with Covid-19. Mediterranean Journal of Hematology and Infectious Disease. 2022; 14(1): 1-11.

Payus AO, Noh MM, Azizan N, and MR Chettiar. SARS-Cov-2-Induced Liver Injury: A Review Article on the High-Risk Populations, Manifestations, Mechanisms, Pathological Changes, Management, and Outcomes. World Journal of Gastroenterology. 2022; 28(39): 5723-5730.

Fu Y, Du S, Liu X, Cao L, Yang G, and Chen H. A Linear Relationship Between De Ritis Ratio and Mortality in Hospitalized Patients with Covid-19: A Secondary Analysis Based on a Large Retrospective Cohort Study. iLIVER. 2022; 1(3): 169-175.

Yadlapati S, Lo KB, DeJoy R, et al. Prevailing Patterns of Liver Enzymes in Patients with Covid-19 Infection and Association with Clinical Outcomes. Annals of Gastroenterology. 2021; 34(2): 224-228.

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Published

2024-08-30

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Research Article