Using Second Measurement of De Ritis Ratio to Improve Mortality Prediction in Adult Trauma Patients in Intensive Care Unit

Abstract

The De Ritis ratio (DRR), the ratio of serum levels of aspartate aminotransferase/alanine aminotransferase, has been reported to be a valuable biomarker in risk stratification for many liver and non-liver diseases. This study aimed to explore whether the inclusion of DRR at the date of intensive care unit (ICU) admission or days after ICU admission improves the predictive performance of various prognosis prediction models. This study reviewed 888 adult trauma patients (74 deaths and 814 survivors) in the trauma registered database between 1 January 2009, and 31 December 2020. Medical information with AST and ALT levels and derived DRR at the date of ICU admission (1st DRR) and 3-7 day after ICU admission (2nd DRR) was retrieved. Logistic regression was used to build new probability models for mortality prediction using additional DRR variables in various mortality prediction models. There was no significant difference in the 1st DRR between the death and survival patients; however, there was a significantly higher 2nd DRR in the death patients than the survival patients. This study showed that the inclusion of the additional DRR variable, measured 3-7 days after ICU admission, significantly increased the prediction performance in all studied prognosis prediction models.

Keywords: De Ritis ratio (DRR); alanine aminotransferase (ALT); aspartate aminotransferase (AST); intensive care unit (ICU); mortality; trauma.

Figure 1

Flowchart demonstrating the inclusion of hospitalized adult trauma patients admitted into the intensive care unit. After the exclusion of patients who had hepatocellular carcinoma, pre-existed decompensated cirrhosis, and lacked AST or ALT data, the study population was grouped into the death (n = 74) and survival groups (n = 814).

Figure 2

The receiver operating characteristic curves and the area under the curve (AUCROC) of the 1st and 2nd DRR to predict the mortality of the adult trauma patients in the intensive care unit.

Figure 3

The receiver operating characteristic curves and the area under the curve (AUCROC) of the prognosis prediction models in predicting mortality (left above figure) and those curves with inclusion of the 2nd DRR (right above figure) or 2nd AST (left lower figure) as an additional variable in the mortality outcome prediction.