De Ritis (AST/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement.

Authors

Haitham Abu Khadija, Jebrin Alkrinawi, Ali Abdullah, Omar Ayyad, Ammar Barakat, Salma Najjar, Alexander Kogan, Leonid Sternik, Alaa Shehady, Mohammad Masu'd, Duha Najajra, Mohammad Alnees

Published in

PloS one. Volume 21. Issue 7. Pages e0354267. Epub Jul 28, 2026.

Abstract

Simple biochemical markers that capture systemic stress could refine short-term risk stratification after TAVR. We evaluated whether an elevated AST/ALT ratio predicts early adverse outcomes following transfemoral TAVR.
We retrospectively analyzed 733 consecutive patients undergoing transfemoral TAVR. The exposure was the preprocedural AST/ALT ratio categorized as low (<1.4; n = 478) or high (≥1.4; n = 255). Baseline characteristics were compared using t/Wilcoxon tests and χ²/Fisher's exact tests. Thirty-day endpoints included all-cause mortality, acute kidney injury (AKI), stroke, and new-onset atrial fibrillation (NOAF). Kaplan-Meier failure curves were compared by the log-rank test. Cox models estimated hazard ratios (HRs) with 95% CIs; candidate covariates were prespecified and further refined with LASSO (10-fold cross-validation). Model assumptions were checked with Schoenfeld residuals.
High AST/ALT was associated with greater 30-day risk of AKI (adjusted HR 3.18, 95% CI 1.80-5.63), stroke (adjusted HR 2.73, 95% CI 1.31-5.69), and NOAF (adjusted HR 2.35, 95% CI 1.57-3.51). For mortality, the crude association was not statistically significant (HR 2.07, 95% CI 0.91-4.68; p = 0.082) and remained non-significant after adjustment (HR 1.74, 95% CI 0.75-4.04; p = 0.197). Additional adjusted associations included higher AKI risk with high-intensity statins (HR 3.51, 95% CI 1.75-7.06) and baseline complete right bundle-branch block (HR 3.77, 95% CI 1.49-9.57).
An elevated preprocedural AST/ALT ratio independently identifies TAVR recipients at increased 30-day risk of AKI, stroke, and NOAF, but not mortality. Incorporating this inexpensive marker into routine assessment may help tailor periprocedural strategies and early surveillance after TAVR.

PMID:
42520093
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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