Prognostic value of the De Ritis ratio for 1-year major adverse cardiovascular events in elderly patients with acute decompensated heart failure
References
- GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392:1789–858.
- McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42:3599–726.
- Díez-Villanueva P, Alfonso F. Heart failure in the elderly. J Geriatr Cardiol. 2016; 13:115–7.
- Kanai M, Minamisawa M, Motoki H, Seko Y, Kimura K, Okano T, et al. Prognostic impact of hyperpolypharmacy due to noncardiovascular medications in patients after acute decompensated heart failure – insights from the clue of risk stratification in elderly patients with heart failure (CURE-HF) registry. Circ J. 2024; 88:33–42.
- Skoularigkis S, Kourek C, Xanthopoulos A, Briasoulis A, Androutsopoulou V, Magouliotis D, et al. Prognostic models in heart failure: hope or hype? J Pers Med. 2025; 15:345. doi: 10.3390/jpm15080345
- Kaplon-Cieslicka A, Drozdz J, Filipiak KJ. Prognostic factors in heart failure – are they all equally important? Kardiol Pol. 2017; 75:519–26.
- Shrivastava A, Haase T, Zeller T, Schulte C. Biomarkers for heart failure prognosis: proteins, genetic scores and non-coding RNAs. Front Cardiovasc Med. 2020; 7:601364. doi: 10.3389/fcvm.2020.601364
- Botros M, Sikaris KA. The de Ritis ratio: the test of time. Clin Biochem Rev. 2013; 34:117–30.
- Djakpo DK, Wang ZQ, Shrestha M. The significance of transaminase ratio (AST/ALT) in acute myocardial infarction. Arch Med Sci Atheroscler Dis. 2020; 5:279–83.
- Maeda D, Kagiyama N, Jujo K, Saito K, Kamiya K, Saito H, 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. doi: 10.1038/s41598-021-91368-z
- Schupp T, Rusnak J, Weidner K, Ruka M, Egner-Walter S, Dudda J, et al. Prognostic value of the AST/ALT ratio versus bilirubin in patients with cardiogenic shock. J Clin Med. 2023; 12:5275. doi: 10.3390/jcm12165275
- Cao Y, Guo S, Dong Y, Liu C, Zhu W. Comparison of liver fibrosis scores for predicting mortality and morbidity in heart failure with preserved ejection fraction. ESC Hear Fail. 2023; 10:1771–80.
- Naschitz JE, Slobodin G, Lewis RJ, Zuckerman E, Yeshurun D. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J. 2000; 140:111–20.
- World Health Organization. Nutritional anaemias: report of a WHO scientific group [meeting held in Geneva from 13 to 17 March 1967]. World Heal Organ Tech Rep Ser. 1968; 405:5–37.
- Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39:3021–104.
- American Diabetes Association. Standards of medical care in diabetes—2022 abridged for primary care providers. Clin Diabetes. 2022; 40:10–38.
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3:1–150.
- Nikolaou M, Parissis J, Yilmaz MB, Seronde MF, Kivikko M, Laribi S, et al. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J. 2013; 34:742–9.
- Xanthopoulos A, Starling RC, Kitai T, Triposkiadis F. Heart failure and liver disease: cardiohepatic interactions. JACC Hear Fail. 2019; 7:87–97.
- Kalas MA, Chavez L, Leon M, Taweesedt PT, Surani S. Abnormal liver enzymes: a review for clinicians. World J Hepatol. 2021; 13:1688–98.
- Josiak K, Jankowska EA, Piepoli MF, Banasiak W, Ponikowski P. Skeletal myopathy in patients with chronic heart failure: significance of anabolic-androgenic hormones. J Cachexia Sarcopenia Muscle. 2014; 5:287–96.
- Peng X, Du J, Wang Y. Metabolic signatures in post-myocardial infarction heart failure, including insights into prediction, intervention, and prognosis. Biomed Pharmacother. 2024; 170:116079. doi: 10.1016/j.biopha.2023.116079
- Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017; 19:1574–85.
- Ndrepepa G. De Ritis ratio and cardiovascular disease: evidence and underlying mechanisms. J Lab Precis Med. 2023; 8:6. doi: 10.21037/jlpm-22-68
- Liu H, Ding C, Hu L, Li M, Zhou W, Wang T, et al. The association between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension. Medicine (Baltimore). 2021; 100:e26693. doi: 10.1097/MD.0000000000026693
- Ndrepepa G, Holdenrieder S, Kastrati A. De Ritis ratio and long-term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention. Eur J Clin Invest. 2023; 53:e13942. doi: 10.1111/eci.13942
- Steininger M, Winter MP, Reiberger T, Koller L, El-Hamid F, Forster S, et al. De-Ritis ratio improves long-term risk prediction after acute myocardial infarction. J Clin Med. 2018; 7:474. doi: 10.3390/jcm7120474
- Ferrannini G, Rosenthal N, Hansen MK, Ferrannini E. Liver function markers predict cardiovascular and renal outcomes in the CANVAS Program. Cardiovasc Diabetol. 2022; 21:127. doi: 10.1186/s12933-022-01558-w
- Ruiz-Laiglesia FJ, Sánchez-Marteles M, Pérez-Calvo JI, Formiga F, Bartolomé-Satué JA, Armengou-Arxé A, et al. Comorbidity in heart failure. Results of the Spanish RICA registry. QJM. 2014; 107: 989–94.
- Lorlowhakarn K, Arayakarnkul S, Trongtorsak A, Leesutipornchai T, Kewcharoen J, Sinphurmsukskul S, et al. Outcomes and predictors of one-year mortality in patients hospitalized with acute heart failure. Int J Cardiol Heart Vasc. 2022; 43:101159. doi: 10.1016/j. ijcha.2022.101159
- Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145:e895–e1032.
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:
Related subjects:
© 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.