Skip to main content
Have a personal or library account? Click to login
Prognostic value of the De Ritis ratio for 1-year major adverse cardiovascular events in elderly patients with acute decompensated heart failure Cover

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: ,  ,   and    
Open Access
|Apr 2026
Figures & tables

Figures & Tables

Figure 1.

ROC curve of the De Ritis ratio for predicting 1-year MACEs in elderly patients hospitalized with acute decompensated HF. AUC, area under the curve; CI, confidence interval; HF, heart failure; MACEs, major adverse cardiovascular events; ROC, receiver operating characteristic.

Figure 2.

Kaplan-Meier survival curves for 1-year MACEs stratified by tertiles of the De Ritis ratio. MACEs, major adverse cardiovascular events.

Baseline characteristics of patients hospitalized with ADHF according to tertiles of the De Ritis ratio

VariablesTotal cohort (n = 249)De Ritis ratioP
1st tertile (n = 82)2nd tertile (n = 88)3rd tertile (n = 79)
Age, years, Me (IQR)78 (70; 85)74 (70; 81.2)81.5 (73; 89)78 (70; 84)0.003
Female, n (%)134 (53.8)42 (51.2)53 (60.2)39 (49.4)0.316
Arterial hypertension, n (%)215 (86.3)68 (82.9)79 (89.8)68 (86.1)0.429
CAD, n (%)157 (63.1)47 (57.3)57 (64.8)53 (67.1)0.402
Previous MI, n (%)95 (38.2)28 (34.1)36 (40.9)31 (39.2)0.644
Dyslipidemia, n (%)233 (93.6)75 (91.5)86 (97.7)72 (91.1)0.141
Diabetes mellitus, n (%)93 (37.3)22 (26.8)34 (38.6)37 (46.8)0.031
Previous CVA, n (%)57 (22.9)13 (15.9)24 (27.3)20 (25.3)0.172
Atrial fibrillation, n (%)121 (48.6)39 (47.6)41 (46.6)41 (51.9)0.770
CKD, n (%)168 (67.5)53 (64.6)59 (67)56 (70.9)0.695
Chronic lung disease, n (%)27 (10.8)10 (12.2)7 (8.0)10 (12.7)0.553
Anemia, n (%)130 (52.2)40 (48.8)45 (51.1)45 (57)0.565
Chest pain, n (%)41 (16.5)12 (14.6)13 (14.8)16 (20.3)0.547
Dyspnea, n (%)241 (96.8)80 (97.6)85 (96.6)76 (96.2)0.880
Peripheral edema, n (%)71 (28.5)19 (23.2)23 (26.1)29 (36.7)0.136
NYHA class III-IV, n (%)137 (55)24 (29.3)49 (55.7)64 (81)<0.001
Systolic blood pressure, mm Hg, Me (IQR)120 (110; 138)121.5 (115; 133.7)121.5 (110.5; 139.7)120 (110; 137)0.640
Diastolic blood pressure, mm Hg, Me (IQR)70 (61.5; 80)70 (63; 80)75 (65; 80)70 (60; 80)0.436
Heart rate, bpm, Me (IQR)89 (82; 100.5)86.5 (79.7; 100)89 (80.5; 102.7)92 (82; 105)0.313
NT-proBNP, Me (IQR), pg/mL, Me (IQR)5,211 (2,887; 10,202)2,892 (2,156; 4,668)5,367 (3,117; 9,349)8,606 (5,639; 17,891)<0.001
Hemoglobin, g/đL, Me (IQR)12.2 (10.5; 13.8)12.3 (10.9; 13.8)12 (10.3; 13.5)12.0 (10.3; 14)0.595
Creatinine, μmol/L, Me (IQR)110 (88; 134.5)107.5 (91; 127)114 (84.2; 137.7)113 (88; 141)0.791
eGFR, mL/min/1.73 m2, Me (IQR)48.4 (36.2; 66.8)52 (37; 68.8)46.4 (32.1; 64.6)47.1 (38.2; 66.4)0.286
AST, U/L, Me (IQR)45 (33; 62.5)35.5 (28.7; 49.5)45 (34; 66.7)55 (41; 79)<0.001
ALT, U/L, Me (IQR)33 (25; 47.5)37 (29; 51.2)33 (25.2; 50.2)32 (23; 44)0.012
LVEF, %, Me (IQR)40 (28; 53)45 (34.2; 60)42 (30; 52)32 (20; 45)<0.001
TAPSE, mm, Me (IQR)19 (17; 20)19 (17; 20)19 (17; 20)18 (16; 20)0.305
IVC, mm, Me (IQR)20 (19; 21)19 (18.7; 21)20 (19; 21.7)21 (19; 22)0.018
IVC ≥ 21 mm100 (40.2)22 (26.8)36 (40.9)42 (53.2)0.003
Discharge medications, n (%)
Beta-blocker111 (44.6)45 (54.9)34 (38.6)32 (40.5)0.07
RAAS inhibitor194 (77.9)65 (79.3)66 (75)63 (79.7)0.713
SGLT2i121 (48.6)41 (50)41 (46.6)39 (49.4)0.894
MRAs131 (52.6)48 (58.5)40 (45.5)43 (54.4)0.216
Loop diuretics232 (93.2)77 (93.9)78 (88.6)77 (97.5)0.074

One-year MACEs in the study population stratified by tertiles of the De Ritis ratio

VariablesTotal cohort (n = 249)De Ritis ratioP
1st tertile (n = 82)2nd tertile (n = 88)3rd tertile (n = 79)
All-cause death
In-hospital mortality, n (%)15 (6)2 (2.4)9 (10.2)4 (5.1)0.094
1-year mortality, n (%)53 (21.3)7 (8.5)19 (21.6)27 (34.2)<0.001
MACEs150 (60.2)26 (31.7)57 (64.8)67 (84.8)
Overall 1-year mortality, n (%)68 (27.3)9 (11)28 (31.8)31 (39.2)<0.001
HF rehospitalization, n (%)79 (31.7)15 (18.3)27 (30.7)37 (46.8)
MI, n (%)10 (4.0)1 (1.2)3 (3.4)6 (7.6)
Stroke, n (%)15 (6.0)0 (0)11 (12.5)4 (5.1)

Cox proportional hazards regression analysis for predictors of 1-year MACEs

VariablesUnivariateMultivariate
HR (95% CI)PHR (95% CI)P
Age (years)1.026 (1.002-1.044)0.0031.002 (0.983-1.022)0.820
Female1.268 (0.918-1.751)0.1491.231 (0.859-1.765)0.258
Arterial hypertension1.185 (0.724-1.939)0.5000.967 (0.571-1.638)0.901
CAD1.930 (1.354-2.751)<0.0011.221 (0.820-1.819)0.326
Atrial fibrillation0.868 (0.629-1.197)0.3870.850 (0.605-1.194)0.349
Diabetes mellitus2.941 (2.126-4.068)<0.0011.480 (1.011-2.167)0.044
Chronic lung disease1.670 (1.052-2.652)0.031.695 (1.010-2.845)0.046
Previous CVA2.348 (1.659-3.323)<0.0011.497 (1.021-2.197)0.039
Anemia1.286 (0.931-1.775)0.1271.154 (0.820-1.624)0.412
logNT-proBNP11.134 (7.098-17.456)<0.0013.760 (2.066-6.844)<0.001
LVEF ≤ 40%2.409 (1.726-3.363)<0.0011.559 (1.057-2.298)0.025
eGFR < 60 mL/min/1.73 m21.572 (1.094-2.259)0.0141.010 (0.664-1.538)0.961
De Ritis ratio >1.304.378 (2.962-6.472)<0.0012.362 (1.536-3.634)<0.001
DOI: https://doi.org/10.2478/abm-2026-0012 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
Journal RSS Feed
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)
Previous article
Next article