A Cohort Study on the Aspartate Aminotransferase and Alanine Aminotransferase Ratio (De Ritis Ratio) as a Reliable Marker of Outcome in Patients with Acute Ischemic Stroke

Introduction: Functional prognosis after an Acute Ischaemic Stroke (AIS) has been linked to two blood enzymes: Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT). The metabolic effects of AST and ALT in decreasing blood glutamate levels may account for this association. Aim: To establish a correlation between AIS, its severity and mortality with their De Ritis ratio (AST/ALT). Materials and Methods: In this hospital-based prospective cohort study conducted at the Department of Medicine at Acharya Vinoba Bhave Rural Teaching Hospital, Wardha, Maharashtra, India, 100 AIS patients were enrolled from December 2020 to December 2022. The parameters used in this study included the Aspartate Aminotransferase/Alanine Transaminase Ratio (AAR), AST, ALT, age, Body Mass Index (BMI) and hypertension. The patients were categorised into four subgroups according to AAR quartiles. The National Institutes of Health Stroke Scale (NIHSS) score was calculated at admission and the modified Rankin Scale (mRS) score was assessed at a 3-month follow-up period. Univariate and multivariate non conditional logistic regression models were employed to assess the relationship between AAR quartiles and outcomes among AIS patients. An association of the De Ritis ratio with these scores was evaluated. Microsoft Office Excel was used for data entry and Statistical Package for the Social Sciences (SPSS) version 28.0 was used for analysis. Results: In the patients’ demographic information, including their past medical history and co-morbidities, 94.0% of the patients were aged ≥40 years, with a mean age of 58.16±13.44 years. The anthropometric measurements (BMI=23.89±2.42 kg/m2 ) and blood indices of all patients were compared and highlighted in the baseline characteristics. There was a significant association between disease severity, as per the NIHSS score and the De Ritis ratio (p=0.038). Disease severity increased significantly with the De Ritis ratio. Additionally, there was a significant association between the outcome 3 months after discharge (mRS score) and the ratio of AST to ALT (p=0.043). Notably, 42.9% of deaths occurred in patients with a De Ritis ratio >1.45. Patients with higher NIHSS and mRS scores were significantly associated with an elevated De Ritis ratio. Conclusion: The De Ritis ratio (AST/ALT) relates to the severity of stroke (NIHSS score), poor outcomes (mRS score) and mortality. The value of the De Ritis ratio can be used as a reliable assessment tool for the prognosis of patients with AIS. The De Ritis ratio can serve as a non invasive and cost-effective tool for assessing AIS, differentiating stroke severity and predicting mortality.