Prognostic value of the De Ritis ratio for 1-year major adverse cardiovascular events in elderly patients with acute decompensated heart failure

Truong Huy Hoang; Dan Van Buu Do; Nguyen Khoi Dang; Thao Le Phuong Nguyen

doi:10.2478/abm-2026-0012

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Prognostic value of the De Ritis ratio for 1-year major adverse cardiovascular events in elderly patients with acute decompensated heart failure

Asian Biomedicine

Volume 20 (2026): Issue 2 (April 2026)

By: Truong Huy Hoang, Dan Van Buu Do, Nguyen Khoi Dang and Thao Le Phuong Nguyen

Open Access

|Apr 2026

Abstract

Background

The De Ritis ratio, derived from serum aspartate aminotransferase and alanine aminotransferase levels, has shown prognostic value in cardiovascular diseases. Its role in elderly patients hospitalized with acute decompensated heart failure (ADHF) remains uncertain.

Objectives

To evaluate the prognostic value of the De Ritis ratio for 1-year major adverse cardiovascular events (MACEs) in elderly patients with ADHF.

Methods

A single-center, prospective cohort of 249 patients aged ≥65 years (median age 78, 53.8% female) hospitalized with ADHF was enrolled. Patients were categorized into tertiles by De Ritis ratio: <1.18 (n = 82), 1.18-1.49 (n = 88), and ≥l.49 (n = 79). The primary outcome was 1-year MACEs, including all-cause death, non-fatal myocardial infarction, stroke, and heart failure (HF) rehospitalization. Cox regression was used to identify independent predictors.

Results

At 1 year, 68 patients (27.3%) died and 150 (60.2%) experienced MACEs. The event rate increased progressively across tertiles: 31.7%, 64.8%, and 84.8% (P < 0.001). The De Ritis ratio was significantly associated with age, diabetes mellitus, advanced HF symptoms, N-terminal pro-B-type natriuretic peptide, and reduced left ventricular ejection fraction. The optimal cutoff for predicting MACEs was 1.30 (C-statistic: 0.760, 95% confidence interval [CI]: 0.697-0.823, P < 0.001), with 78% sensitivity and 72.7% specificity. A De Ritis ratio >1.30 independently predicted outcomes (hazard ratio: 2.362; 95% CI: 1.536-3.634; P < 0.001).

Conclusions

An elevated De Ritis ratio is an independent predictor of 1-year MACEs in elderly patients with ADHF. This simple, accessible biomarker may aid clinical risk stratification.

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Articles in this issue

DOI: https://doi.org/10.2478/abm-2026-0012 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415

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Language: English

Page range: 114 - 122

Published on: Apr 30, 2026

Published by: Chulalongkorn University

In partnership with: Paradigm Publishing Services

Publication frequency: 6 issues per year

Keywords:

acute decompensated heart failure,

alanine aminotransferase,

aspartate aminotransferase,

De Ritis ratio,

elderly,

major adverse cardiovascular events,

risk stratification

Related subjects:

Medicine,

Assistive professions, nursing,

Basic medical science,

Basic medical science, other,

Clinical medicine,

Clinical medicine, other

© 2026 Truong Huy Hoang, Dan Van Buu Do, Nguyen Khoi Dang, Thao Le Phuong Nguyen, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 20 (2026): Issue 2 (April 2026)