De Ritis (AST/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement.
H, A.K., J, A., A, A., O, A., A, B., S, N., A, K., L, S., A, S., & M, M. (2026). De Ritis (AST/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement.. PloS one. https://doi.org/10.1371/journal.pone.0354267
H AK, J A, A A, O A, A B, S N, et al. De Ritis (AST/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement.. PloS one. 2026; doi: 10.1371/journal.pone.0354267
H AK, J A, A A, et al. De Ritis (AST/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement.[J]. PloS one. 2026. DOI: 10.1371/journal.pone.0354267.
@article{h2026,
author = {Abu Khadija H and Alkrinawi J and Abdullah A and Ayyad O and Barakat A and Najjar S and Kogan A and Sternik L and Shehady A and Masu'd M},
title = {De Ritis (AST/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement.},
journal = {PloS one},
year = {2026},
doi = {10.1371/journal.pone.0354267},
note = {PMID: 42520093},
}
TY - JOUR AU - Abu Khadija H AU - Alkrinawi J AU - Abdullah A AU - Ayyad O AU - Barakat A AU - Najjar S AU - Kogan A AU - Sternik L AU - Shehady A AU - Masu'd M TI - De Ritis (AST/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement. T2 - PloS one PY - 2026 DO - 10.1371/journal.pone.0354267 AN - PMID:42520093 ER -
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.