Association of AST/ALT ratio with 90-day outcomes in patients with acute exacerbation of chronic liver disease: a prospective multicenter cohort study in China

Huimin Liu; Hai Li; Guohong Deng; Xin Zheng; Yan Huang; Jinjun Chen; Zhongji Meng; Yanhang Gao; Zhiping Qian; Feng Liu; Xiaobo Lu; Yu Shi; Jia Shang; Huadong Yan; Yubao Zheng; Zixuan Shen; Liang Qiao; Weituo Zhang; Xianbo Wang

doi:10.3389/fmed.2024.1307901

Association of AST/ALT ratio with 90-day outcomes in patients with acute exacerbation of chronic liver disease: a prospective multicenter cohort study in China

Front Med (Lausanne). 2024 Mar 21:11:1307901. doi: 10.3389/fmed.2024.1307901. eCollection 2024.

Authors

Huimin Liu^#^{1

2}, Hai Li^#³, Guohong Deng^#⁴, Xin Zheng^#⁵, Yan Huang^#⁶, Jinjun Chen^#⁷, Zhongji Meng⁸, Yanhang Gao⁹, Zhiping Qian¹⁰, Feng Liu¹¹, Xiaobo Lu¹², Yu Shi¹³, Jia Shang¹⁴, Huadong Yan¹⁵, Yubao Zheng¹⁶, Zixuan Shen³, Liang Qiao³, Weituo Zhang¹⁷, Xianbo Wang¹

Affiliations

¹ Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
² Department of Traditional Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
³ Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
⁵ Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China.
⁷ Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁸ Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China.
⁹ Department of Hepatology, The First Hospital of Jilin University, Changchun, China.
¹⁰ Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China.
¹¹ Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China.
¹² Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
¹³ The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China.
¹⁴ Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China.
¹⁵ Department of Hepatology, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Hwamei Hospital, Ningbo No. 2 Hospital, University of Chinese Academy of Sciences, Ningbo, China.
¹⁶ Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
¹⁷ Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

^# Contributed equally.

Abstract

Background and aim: A high aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is associated with liver injury in liver disease; however, no data exist regarding its relationship with 90-day prognosis in patients with acute exacerbation of chronic liver disease.

Methods: In this study, 3,758 participants (955 with advanced fibrosis and 2,803 with cirrhosis) from the CATCH-LIFE cohort in China were included. The relationships between different AST/ALT ratios and the risk of adverse 90-day outcomes (death or liver transplantation) were determined in patients with cirrhosis or hepatitis B virus (HBV)-associated advanced fibrosis, respectively.

Results: In the patients with HBV-associated advanced fibrosis, the risk of 90-day adverse outcomes increased with AST/ALT ratio; after adjusting for all confounding factors, the risk of adverse 90-day outcomes was the highest when AST/ALT ratio was more than 1.08 (OR = 6.91 [95% CI = 1.789-26.721], p = 0.005), and the AST/ALT ratio of >1.9 accelerated the development of adverse outcomes. In patients with cirrhosis, an AST/ALT ratio > 1.38 increased the risk of adverse 90-day outcomes in all univariables (OR = 1.551 [95% CI = 1.216-1.983], p < 0.001) and multivariable-adjusted analyses (OR = 1.847 [95% CI = 1.361-2.514], p < 0.001), and an elevated AST/ALT ratio (<2.65) accelerated the incidence of 90-day adverse outcomes. An AST/ALT ratio of >1.38 corresponded with a more than 20% incidence of adverse outcomes in patients with cirrhosis.

Conclusion: The AST/ALT ratio is an independent risk factor for adverse 90-day outcomes in patients with cirrhosis and HBV-associated advanced fibrosis. The cutoff values of the AST/ALT ratio could help clinicians monitor the condition of patients when making clinical decisions.

Keywords: advanced fibrosis; aspartate aminotransferase/alanine aminotransferase ratio; cirrhosis; prognosis; risk factor; short-term outcome.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Shanghai Hospital Development Commission (16CR1024B and SHDC2020CR1037B); National Science and Technology Major Project (2018ZX10302206 and SQ2017YFSF090159); Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support; Chongqing Natural Science Foundation (CSTC2019jcyj-zdxmX0004); National Natural Science Foundation of China (81930061, 81900579, 81473641, 81271884, 81461130019, 81700561, 81660333, and 81870425); National Natural Science Foundation of China National Science and Technology Major Project (2018ZX10723203); Beijing Natural Science Foundation (7232328); Department of Science and Technology of Guangdong Province (2015B020226004); Foundation for Innovative Research Groups of the Natural Science Foundation of Hubei Province of China (2018CFA031); National Science and Technology Major Project (2017ZX10202202); National Key Research Plan “Precision Medicine Research” Key Project (2017YFC0908103); Shandong Province Natural Science Foundation (ZR2019PH052); 12–5 State S&T Projects of China (2018ZX10302-206); Capital health development research project (2024–1-2173).