Liver damage in COVID-19 patients was documented as increased alanine aminotransferase
(ALT) and aspartate aminotransferase (AST) levels or an elevated AST/ALT ratio, known
as the De Ritis ratio. However, the prognostic value of the elevated De Ritis ratio
in COVID-19 patients is still unknown. The aim of our study was to evaluate the prognostic
value of the De Ritis ratio compared to other abnormal laboratory parameters and its
relation to mortality. We selected 322 COVID-19 patients in this retrospective study
conducted between November 2020 and March 2021. The laboratory parameters were measured
on admission and followed till patient discharge or death. Of the 322 COVID-19 patients,
57 (17.7%) had gastrointestinal symptoms on admission. The multivariate analysis showed
that the De Ritis ratio was an independent risk factor for mortality, with an OR of
29.967 (95% CI 5.266–170.514). In ROC analysis, the AUC value of the the De Ritis
ratio was 0.85 (95% CI 0.777–0.923, p < 0.05) with sensitivity and specificity of
80.6% and 75.2%, respectively. A De Ritis ratio ≥1.218 was significantly associated
with patient mortality, disease severity, higher AST and IL-6 levels, and a lower
ALT level. An elevated De Ritis ratio on admission is independently associated with
mortality in COVID-19 patients, indicating liver injury and cytokine release syndrome.
