Delta De Ritis Ratio Is Associated with Worse Mortality Outcomes in Adult Trauma Patients with Moderate-to-Severe Traumatic Brain Injuries

Abstract

This study aimed to investigate whether changes in the De Ritis ratio (DRR) can be used to stratify the mortality risk of patients with moderate-to-severe traumatic brain injury (TBI). This retrospective study reviewed data for 1347 adult trauma patients (134 deaths and 1213 survival) with moderate-to-severe TBI between 1 January 2009, and 31 December 2020, from the registered trauma database. The outcomes of the patients allocated into the two study groups were compared based on the best Delta DRR (ΔDRR) cutoff point. The first and second DRR of patients who died were significantly higher than those of patients who survived. Elevation of DRR 72-96 h later was found for patients who died, but not for those who survived; the ΔDRR of the patients who died was significantly higher than that of those who survived (1.4 ± 5.8 vs. -0.1 ± 3.3, p = 0.004). Multivariate logistic regression analysis revealed that ΔDRR was a significant independent risk factor for mortality in these patients. Additionally, a ΔDRR of 0.7 was identified as the cutoff value for mortality stratification of adult trauma patients at high risk of mortality with moderate-to-severe TBI.

Keywords: De Ritis ratio; alanine aminotransferase; aspartate aminotransferase; delta De Ritis ratio; mortality; traumatic brain injury.

Figure 1

Flowchart illustrating the inclusion of hospitalized adult trauma patients with moderate-to-severe traumatic brain injuries from the registered trauma database. Those patients who lacked the first AST or ALT data upon arrival at the emergency room and at 72–96 h later, were excluded from the study population.

Figure 2

Receiver operating characteristic curves and area under the curve (AUC) of the delta De Ritis ratio for predicting the mortality of the adult trauma patients with moderate-to-severe traumatic brain injuries.