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. 2023 Mar 17;23(1):168.
doi: 10.1186/s12879-023-08121-2.

Serum mAST/ALT ratio had high predictive value for adverse outcome of severe fever with thrombocytopenia syndrome with severe condition

Li Wang  1 , Youde Liu  2 , Renliang Qu  3 , Zhiqiang Zou  2
Affiliations

Serum mAST/ALT ratio had high predictive value for adverse outcome of severe fever with thrombocytopenia syndrome with severe condition

Li Wang et al. BMC Infect Dis. .

Abstract

Background: Severe fever with thrombocytopenia syndrome (SFTS) usually demonstrates multi-organ injury with a high mortality rate. This study aimed to investigate associations of serum aspartate/alanine aminotransferase (AST)/ALT, cytosolic AST (cAST)/ALT and mitochondrial AST (mAST)/ALT ratios with the prognosis of SFTS patients.

Methods: A total of 355 confirmed SFTS patients were included. Clinical and laboratory data were compared between survivors and nonsurvivors. Logistic regression analysis was used to assess the independent risk factors for fatality in all patients and those admitted to the intensive care unit (ICU). The predictive values of the risk factors and constructed risk models were evaluated.

Results: Mean age and biochemical parameters were significantly greater in nonsurvivors than in survivors. In ICU patients, the three ratios, high-sensitivity troponin I (hsTnI), creatine kinase (CK), lactate dehydrogenase (LDH) and α-hydroxybutyrate dehydrogenase (α-HBDH) were elevated markedly in nonsurvivors than in survivors. Multivariate logistic regression analysis showed that age, three ratios and α-HBDH were independent risk factors for mortality in all patients. Only the three ratios were independent risk factors for death in ICU patients. Risk Models (M1, M2 and M3) and simplified models (sMs) containing the three ratios respectively had comparatively high predictive values for fatality in all patients with area under ROC curves (AUCs) > 0.85. In ICU patients, mAST/ALT ratio had the highest predictive value, sensitivity and odds ratio (OR) for mortality among three ratios.

Conclusion: AST/ALT, cAST/ALT and mAST/ALT ratios were associated with unfavorable clinical outcome of SFTS. The prognostic value of mAST/ALT ratio was higher in severe cases.

Keywords: AST/ALT ratio; Risk factor; Severe fever with thrombocytopenia syndrome; cAST/ALT ratio; mAST/ALT ratio.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
ROC of simplified risk models (sM1, sM2 and sM3) for the prediction of SFTS prognosis. (a-c) ROC curves of sM1, sM2 and sM3 for predicting SFTS mortality in all patients. (d-f) ROC curves of AST/ALT ratio, mAST/ALT ratio and cAST/ALT ratio for the prediction of SFTS mortality in ICU patients
Fig. 2
Fig. 2
Survival curves. (a-c) Survival curves of sM1, sM2 and sM3 for cumulative survival rates of all patients. (d-f) Survival curves of AST/ALT ratio, mAST/ALT ratio and cAST/ALT ratio for cumulative survival rates of ICU patients
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