CLINICAL RESEARCH
Aspartate aminotransferase to alanine aminotransferase ratio and short-term prognosis of patients with type 2 diabetes hospitalized for heart failure
More details
Hide details
1
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, China
2
Department of Endocrinology and Metabolism, Second People’s Hospital of Ya’an City, China
3
Department of Informatics, West China Hospital, Sichuan University, China
4
Department of Endocrinology and Metabolism, The First People’s Hospital of Shuangliu District, China
5
West China School of Medicine, Sichuan University, China
6
Department of Cardiology, West China Hospital, Sichuan University, China
These authors had equal contribution to this work
Submission date: 2023-11-30
Final revision date: 2024-02-04
Acceptance date: 2024-02-15
Online publication date: 2024-10-22
Corresponding author
Sheyu Li
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
KEYWORDS
TOPICS
ABSTRACT
Introduction:
We aimed to explore the prognostic value of the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio in non-surgical patients with type 2 diabetes hospitalized for heart failure.
Material and methods:
Using a large electronic medical record-based cohort of diabetes in China (WECODe), we gathered data on non-surgical hospitalized patients with type 2 diabetes and heart failure from 2011 to 2019. Baseline AST/ALT ratio was calculated. The primary outcomes were all-cause death within 30 days after discharge, composite cardiac events, major acute kidney injury, and major systemic infection. A multivariable Cox proportional regression model was utilized to evaluate the association between the AST/ALT ratio and outcomes.
Results:
This retrospective cohort included 8,073 patients (39.4% women) with type 2 diabetes hospitalized for heart failure. The median age was 71 years. Higher AST/ALT ratio was associated with higher risks of poor endpoints (with per standard deviation increment in AST/ALT ratio, for death within 30 days after discharge: adjusted hazard ratio [HR], 1.35, 95% confidence interval [CI], 1.21 to 1.50; for composite cardiac events: HR, 1.18, 95% CI: 1.06 to 1.31). Compared to patients in the lowest quartile for the AST/ALT ratio, those in the highest quartile have elevated risk of death within 30 days after discharge and major systemic infection (HRs [95% CIs]: 1.61 [1.18 to 2.19] and 1.28 [1.06 to 1.56], respectively). Subgroup analyses and sensitivity analyses confirmed the robustness of the findings.
Conclusions:
Type 2 diabetes patients hospitalized for heart failure with the AST/ALT ratio in the highest quartile face a poor short-term prognosis.
REFERENCES (42)
1.
Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118: 3272-87.
2.
Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020; 22: 1342-56.
3.
Wierzba W, Karnafel W, Śliwczyński A, Pinkas J, Gujski M. Diabetes mellitus and congestive heart failure: the prevalence of congestive heart failure in patients with and without diabetes in Poland. Arch Med Sci 2018; 17: 646-51.
4.
Kosiorek A, Tokarczyk W, Szymański O, et al. Timing of decongestion and its impact on acute heart failure prognosis. Arch Med Sci 2023; 19: 1551-7.
5.
Zhou Y, Wang M, Wang S, et al. Diabetes in patients with heart failure with reduced ejection fraction during hospitalization: a retrospective observational study. Front Endocrinol (Lausanne) 2021; 12: 727188.
6.
Xanthopoulos A, Starling RC, Kitai T, Triposkiadis F. Heart failure and liver disease: cardiohepatic interactions. JACC Heart Fail 2019; 7: 87-97.
7.
Samsky MD, Patel CB, DeWald TA, et al. Cardiohepatic interactions in heart failure: an overview and clinical implications. J Am Coll Cardiol 2013; 61: 2397-405.
8.
Batin P, Wickens M, McEntegart D, Fullwood L, Cowley AJ. The importance of abnormalities of liver function tests in predicting mortality in chronic heart failure. Eur Heart J 1995; 16: 1613-8.
9.
Ambrosy AP, Dunn TP, Heidenreich PA. Effect of minor liver function test abnormalities and values within the normal range on survival in heart failure. Am J Cardiol 2015; 115: 938-41.
10.
Ess M, Mussner-Seeber C, Mariacher S, et al. -Glutamyltransferase rather than total bilirubin predicts outcome in chronic heart failure. J Card Fail 2011; 17: 577-84.
11.
Allen LA, Felker GM, Pocock S, et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Eur J Heart Fail 2009; 11: 170-7.
12.
Liang W, He X, Wu D, et al. Prognostic implication of liver function tests in heart failure with preserved ejection fraction without chronic hepatic diseases: insight from TOPCAT trial. Front Cardiovasc Med 2021; 8: 618816.
13.
De Ritis F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chim Acta 1957; 2: 70-4.
14.
Botros M, Sikaris KA. The de ritis ratio: the test of time. Clin Biochem Rev 2013; 34: 117-30.
15.
Zoppini G, Cacciatori V, Negri C, et al. The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes. Medicine (Baltimore) 2016; 95: e4821.
16.
Ndrepepa G, Holdenrieder S, Kastrati A. Prognostic value of De Ritis ratio in patients with acute myocardial infarction. Clin Chim Acta 2022; 535: 75-81.
17.
Maeda D, Kagiyama N, Jujo K, et al. Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure. Sci Rep 2021; 11: 11957.
18.
Steininger M, Winter MP, Reiberger T, et al. De-Ritis ratio improves long-term risk prediction after acute myocardial infarction. J Clin Med 2018; 7: 474.
19.
Maeda D, Sakane K, Kanzaki Y, et al. Relation of aspartate aminotransferase to alanine aminotransferase ratio to nutritional status and prognosis in patients with acute heart failure. Am J Cardiol 2021; 139: 64-70.
20.
Cao Y, Guo S, Dong Y, et al. Comparison of liver fibrosis scores for predicting mortality and morbidity in heart failure with preserved ejection fraction. ESC Heart Fail 2023; 10: 1771-80.
21.
Zhou Y, Liu L, Huang H, et al. Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes. Cardiovasc Diabetol 2022; 21: 290.
22.
Wang M, Li S, Zheng T, et al. Big data health care platform with multisource heterogeneous data integration and massive high-dimensional data governance for large hospitals: design, development, and application. JMIR Med Inform 2022; 10: e36481.
23.
Zhou Y, Zhang Y, Zhang R, et al. Population diversity of cardiovascular outcome trials and real-world patients with diabetes in a Chinese tertiary hospital. Chin Med J (Engl) 2021; 134: 1317-23.
24.
Zhou Y, Huang H, Yan X, et al. Glycated haemoglobin A1c variability score elicits kidney function decline in chinese people living with type 2 diabetes. J Clin Med 2022; 11: 6692.
25.
Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-12.
26.
Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173: 676-82.
27.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012; 120: c179-84.
29.
Hainmueller J. Entropy balancing for causal effects: a multivariate reweighting method to produce balanced samples in observational studies. Polit Anal 2012; 20: 25-46.
30.
Balan TA, Putter H. A tutorial on frailty models. Stat Methods Med Res 2020; 29: 3424-54.
31.
Li S, Shi Q, Litvin V, et al. Precision medicine in cardiorenal and metabolic diseases with routinely collected clinical data: a novel insight. Precis Clin Med 2022; 5: pbac025.
32.
Lu Z, Ma G, Chen L. De-Ritis ratio is associated with mortality after cardiac arrest. Dis Markers 2020; 2020: 8826318.
33.
Wroblewski F. The clinical significance of alterations in transaminase activities of serum and other body fluids. Adv Clin Chem 1958; 1: 313-51.
34.
Ladue JS, Wroblewski F, Karmen A. Serum glutamic oxaloacetic transaminase activity in human acute transmural myocardial infarction. Science 1954; 120: 497-9.
35.
Bahit MC, Kochar A, Granger CB. Post-myocardial infarction heart failure. JACC Heart Fail 2018; 6: 179-86.
36.
Dong MH, Bettencourt R, Brenner DA, Barrett-Connor E, Loomba R. Serum levels of alanine aminotransferase decrease with age in longitudinal analysis. Clin Gastroenterol Hepatol 2012; 10: 285-90.e1.
37.
Dong MH, Bettencourt R, Barrett-Connor E, Loomba R. Alanine aminotransferase decreases with age: the Rancho Bernardo Study. PLoS One 2010; 5: e14254.
38.
Le Couteur DG, Blyth FM, Creasey HM, et al. The association of alanine transaminase with aging, frailty, and mortality. J Gerontol A Biol Sci Med Sci 2010; 65: 712-7.
39.
Bellanti F, Vendemiale G. The aging liver: redox biology and liver regeneration. Antioxid Redox Signal 2021; 35: 832-47.
40.
Fortea JI, Puente Á, Cuadrado A, et al. Congestive hepatopathy. Int J Mol Sci 2020; 21: 9420.
41.
Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005; 172: 367-79.
42.
Rej R. Aminotransferases in disease. Clin Lab Med 1989; 9: 667-87.