COVID-19 Hastalarında De Ritis Oranının Mortalite Üzerindeki Rolü

Öz

Öz Amaç: De Ritis oranı (aspartat aminotransferaz/alanin aminotransferaz), kritik hastalıkta prognostik bir biyobelirteç adayı olarak öne çıkmaktadır. Bu çalışma, COVID-19 tanısı doğrulanmış kritik hastalarda yoğun bakım ünitesi (YBÜ) mortalitesi üzerinde De Ritis oranının bağımsız prognostik değerini belirlemeyi amaçlamıştır. Yöntem: Bu çalışma, tek merkezli retrospektif gözlemsel bir kohort çalışması olarak tasarlanmıştır. RT-PCR ile doğrulanmış COVID-19 tanısıyla Ocak–Aralık 2021 tarihleri arasında İç Hastalıkları YBÜ’ye yatırılan 642 yetişkin hastanın tıbbi kayıtları retrospektif olarak incelenmiştir. YBÜ kabulünde demografik özellikler, komorbid durumlar, laboratuvar parametreleri, klinik ağırlık skorları (APACHE II ve SOFA) ve organ destek gereksinimleri kaydedilmiştir. Hastalar sağ kalan ve sağ kalmayan alt gruplarına ayrılmıştır. YBÜ mortalitesinin bağımsız belirleyicileri, De Ritis oranını yerleşik ağırlık skorlarıyla birlikte içeren iki ayrı çok değişkenli lojistik regresyon modeli aracılığıyla belirlenmiştir. Ayırt edici performans, ROC eğrisi analizi ile değerlendirilmiştir. Bulgular: YBÜ mortalitesi 341 hastada (%53,1) saptanmıştır. Sağ kalmayanlar; sağ kalanlarla karşılaştırıldığında anlamlı düzeyde daha yaşlı olup belirgin biçimde yüksek inflamatuvar biyobelirteç, D-dimer, üre ve De Ritis oranı değerleri sergilemiştir. Mutlak AST ve ALT konsantrasyonları gruplar arasında anlamlı farklılık göstermemesine karşın De Ritis oranı, her iki çok değişkenli modelde YBÜ mortalitesiyle bağımsız olarak ilişkilendirilmiştir (Model A: OR 1,27, %95 GA 1,06–1,51, p = 0,009; Model B: OR 1,26, %95 GA 1,05–1,50, p = 0,013). De Ritis oranının ağırlık skorlarıyla entegrasyonu model ayırımcılığını artırmıştır (AUC 0,661’e kadar). Sonuç: YBÜ kabulünde ölçülen De Ritis oranı, kritik COVID-19 hastalarında mortaliteyi bağımsız olarak öngörmüş ve yerleşik ağırlık skorlama sistemlerinin ötesinde ek prognostik bilgi sağlamıştır. Rutin laboratuvar verilerinden elde edilebilmesi, bu oranın maliyet-nötr bir tamamlayıcı sınıflandırma aracı olarak potansiyelini desteklemektedir.

Anahtar Kelimeler

• COVID-19
• De Ritis oranı
• Yoğun bakım mortalitesi

The Role of the De Ritis Ratio in ICU Mortality Among Critically Ill Patients with COVID-19

Öz

Abstract Objective: The De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) has emerged as a prognostic biomarker in critical illness. This study aimed to evaluate the independent prognostic value of the De Ritis ratio for ICU mortality in critically ill patients with COVID-19. Methods: This retrospective observational cohort study was conducted at a single tertiary center. Medical records of 642 adult patients with RT-PCR–confirmed COVID-19 admitted to the Internal Medicine ICU between January and December 2021 were reviewed. Demographic data, comorbidities, laboratory parameters, severity scores (APACHE II and SOFA), and organ support requirements were recorded at ICU admission. Patients were stratified into survivor and non-survivor subgroups. Independent predictors of ICU mortality were identified through two multivariable logistic regression models. Discriminative performance was assessed by receiver operating characteristic curve analysis. Results: ICU mortality was recorded in 341 patients (53.1%). Non-survivors were significantly older and had markedly elevated inflammatory biomarkers, D-dimer, urea, and De Ritis ratio values. Although absolute AST and ALT concentrations did not differ significantly between groups, the De Ritis ratio independently predicted ICU mortality in both models (Model A: OR 1.27, 95% CI 1.06–1.51, p = 0.009; Model B: OR 1.26, 95% CI 1.05–1.50, p = 0.013). Combining the De Ritis ratio with severity scores improved discrimination (AUC up to 0.661). Conclusion: The De Ritis ratio at ICU admission independently predicted mortality in critically ill COVID-19 patients and provided prognostic information beyond established severity scores. Its derivation from routine laboratory data supports its role as a cost-neutral supplementary stratification tool.

Anahtar Kelimeler

• COVID-19
• De Ritis ratio
• ICU mortality

Kaynakça

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