ArticlePloS one2026
De Ritis (AST/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSimple 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.
methodsWe 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.
resultsHigh 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).
conclusionsAn 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.
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