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. 2021 Dec 22:8:676581.
doi: 10.3389/fmed.2021.676581. eCollection 2021.

Elevated De Ritis Ratio Is Associated With Poor Prognosis in COVID-19: A Systematic Review and Meta-Analysis

Raymond Pranata  1 , Ian Huang  1   2 , Michael Anthonius Lim  1 , Emir Yonas  3 , Rachel Vania  1   4 , Antonia Anna Lukito  1   5 , Sally Aman Nasution  6 , Bambang Budi Siswanto  7 , Raden A Tuty Kuswardhani  8
Affiliations

Elevated De Ritis Ratio Is Associated With Poor Prognosis in COVID-19: A Systematic Review and Meta-Analysis

Raymond Pranata et al. Front Med (Lausanne). .

Abstract

Objective: This meta-analysis aims to assess whether elevated De Ritis ratio is associated with poor prognosis in patients with coronavirus 2019 (COVID-19). Methods: A systematic literature search was performed using PubMed, Embase, and EuropePMC databases up until September 17, 2021. De Ritis ratio is also known as Aspartate aminotransferase/alanine transaminase (AST/ALT) ratio. The main outcome was poor prognosis, a composite of mortality, severity, the need for ICU care, and intubation. The effect measure was odds ratios (ORs) and mean differences. We generated sensitivity and specificity, negative and positive likelihood ratio (NLR and PLR), diagnostic odds ratio (DOR), and area under curve (AUC). Results: There were eight studies with 4,606 patients. De Ritis ratio was elevated in 44% of the patients. Patients with poor prognosis have higher De Ritis ratio [mean difference 0.41 (0.31, 0.50), p < 0.001; I 2: 81.0%] and subgroup analysis showed that non-survivors also have higher De Ritis Ratio [mean difference 0.47 (0.46, 0.48), p < 0.001; I 2: 0%]. Elevated De Ritis ratio was associated with poor prognosis [OR 3.28 (2.39, 4.52), p < 0.001; I 2: 35.8%]. It has a sensitivity of 55% (36-73), specificity of 71% (52-85), PLR 1.9, NLR.63, DOR of 3 (2-4), and AUC of.67 (0.63-0.71). The posterior probability of poor prognosis was 38% if De Ritis is elevated, while 17% if De Ritis is not elevated. Conclusion: Elevated De Ritis ratio is associated with poor prognosis in patients with COVID-19. Systematic Review Registration: PROSPERO ID: CRD42020216634.

Keywords: De Ritis ratio; SARS-CoV-2; coronavirus—COVID-19; liver enzyme; transaminase.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Mean difference in aspartate aminotransferase (AST) (A) and alanine transaminase (ALT) (B) level between poor and good prognosis.
Figure 3
Figure 3
Mean difference in De Ritis ratio between poor and good prognosis.
Figure 4
Figure 4
Odds ratio for elevated De Ritis ratio and poor prognosis.
Figure 5
Figure 5
Summary receiver operating characteristic (SROC) curve.
Figure 6
Figure 6
Fagan's nomogram.
See this image and copyright information in PMC

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