Yapay Zeka Hızlı Bakış & Çıkarımlar
AI InsightWe believe that the De Ritis could be a guiding parameter for clinicians in the early identification of critically ill patients in this group.
📌 3 Maddede Bu Makale
Abstract
Aims: The aim of this study is to evaluate the role of De Ritis ratio in predicting intra-hospital mortality in patients treated in intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). The De Ritis ratio is calculated using the formula: aspartate aminotransferase (AST)/alanine aminotransferase (ALT). Methods: Data from 414 patients admitted to the ICU with a diagnosis of COVID-19 at a single-center between March 2020 and March 2022 were retrospectively analyzed. Patients were divided into two groups: survivors and deceased patients. Demographic, clinical, and laboratory data of the patients were compared. Between-group comparisons were performed using the Mann-Whitney U test for continuous variables and Chi-square or Fisher’s exact tests for categorical variables, as appropriate. The performance of the De Ritis ratio in predicting mortality was evaluated using ROC curves, the Youden Index and APACHE-inclusive sensitivity model. Model discrimination was assessed using AUC with bootstrap 95% confidence intervals, calibration using the Brier score and Hosmer-Lemeshow test, multicollinearity using variance inflation factors, and internal validation using bootstrap optimism correction. Results: Of the 414 patients, 211 (51.0%) died. The De Ritis ratio was higher among non-survivors than survivors [median 1.61 (IQR 1.14-2.28) vs 1.17 (IQR 0.86-1.61), p<0.001]. In ROC analysis, the recalculated De Ritis ratio showed modest discrimination for mortality, with an AUC of 0.676 (95% CI 0.625-0.726). The exploratory Youden cut-off was approximately 1.45, with sensitivity 59.7% and specificity 69.5%. In the clinical model not including APACHE score, each two-fold increase in the De Ritis was independently associated with mortality (adjusted OR 1.79, 95% CI 1.28-2.51, p=<0.001). However, in the APACHE-inclusive model, the De Ritis ratio was not independently associated with mortality (adjusted OR 1.49, 95% CI 0.89-2.52, p=0.132). Conclusion: Our results show that the De Ritis ratio is associated with mortality in COVID-19 patients in ICU and may have a limited differential power in univariate analysis. We believe that the De Ritis could be a guiding parameter for clinicians in the early identification of critically ill patients in this group.