Gender-specific association between AST/ALT ratio and 365-day mortality in patients with severe acute pancreatitis: A retrospective cohort study based on the MIMIC-IV database

Patients with acute pancreatitis (AP) in the intensive care unit experience high complication and mortality rates, making early prognosis prediction crucial. While the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio is correlates with prognosis in various diseases, its association with mortality in severe AP remains uncertain. AP patients were identified using the Medical Information Mart for Intensive Care-IV database. Cox proportional hazard regression models examined the link between the AST/ALT ratio and 365-day mortality. Kaplan-Meier survival curve analysis was conducted to assess patient survival across AST/ALT ratio quartiles. restricted cubic splines analysis determined the relationship curve between 365-day mortality and the AST/ALT ratio level. We also conducted subgroup analyses to assess the robustness of the findings. A total of 817 patients were included in this retrospective cohort study. After adjusting for all covariates, the Cox regression model showed that the AST/ALT ratio was positively associated with 365-day mortality in patients with AP (hazard ratio: 1.33, 95% confidence interval: 1.16-1.52). When the AST/ALT ratio was divided into 4 groups based on quartiles, participants in the Q4 group had a significantly higher mortality compared with Q1 (hazard ratio:2.11, 95% confidence interval: 1.30-3.40). The Kaplan-Meier curves showed that patients in the Q1 group had the lowest mortality (log-rank P < .001). The restricted cubic splines curve indicated a linear relationship between the AST/ALT ratio and mortality in AP patients (P for nonlinear > .05). Subgroup analyses further demonstrated that this association was more pronounced in men. Finally, the AST/ALT ratio improved the predictive performance of sequential organ failure assessment score for mortality in patients with AP. In critically ill AP patients, a higher AST/ALT ratio on admission was associated with greater 365-day mortality, especially in males. It is suggested that the AST/ALT ratio can be used as a simple and effective prognostic marker for patients with severe AP.