The Study of De Ritis (Ast/ Alt) Ratio in Comparision with Other Parameters for Predicting Poor Prognosis in Covid 19 Patients.

ABSTRACT

Coronavirus disease which is caused by the SARS CoV2 virus has been spreading rapidly all over the world and is posing threat to public health. There is a need to identify potentially severe or critical cases early using a novel test for preventing fatality. Coronavirus utilizes angiotens in converting enzyme receptors (ACE) for gaining entry to host cells and leads to multiorgan failure. ACE 2 receptors are present in the liver, cardia, skeletal muscles, kidneys, brain, RBCs. These organs also have high concentrations of aspartate aminotransferase enzyme. It is worth noting the increase in AST which would indirectly be used as evidence for severity. MATERIAL: This a cross-sectional retrospective study including 120 non-alcoholic Covid 19 patients (50 survivors and 70 non-survivors), aged > 18 years tested positive for RTPCR and were admitted to our hospital. The results of tests like neutrophil/lymphocyte ratio, CRP, D Dimer, LDH, ferritin, albumin, AST, ALT, AST/ALT ratio, bilirubin, urea, and creatinine values were noted from the case records. All the tests were done on the day of admission. Receiver operator curve analysis was plotted for these parameters and their usefulness in predicting mortality was deduced and compared with AST/ALT ratio. OBSERVATION The mean age of the study group was 50.63 years with 60 % males and 40 % females. Using Mann Whitney test statistical significance of studied parameters was proved with a p-value of <0.005. The ROC curve analysis was performed for all the tests and clinical relevance of the same in terms of predicting mortality between survivors and non-survivors is determined. DE RITIS ratio had the best utility as a predictor of poor prognosis with sensitivity and specificity of 83% and 88% respectively (p-value > 0.001). It surpassed the N/L ratio and CRP for predicting mortality in COVID patients. Cut -off value of the DE RITIS ratio for predicting fatality was 1.28 with a significant p-value of < 0.001. CONCLUSION: DE RITIS ratio can be used as the best parameter among the other novel tests for predicting severity in covid patients for effective resource allocation and timely intervention.