PROGNOSTIC VALUE OF THE AST/ALT RATIO IN PREDICTING FUNCTIONAL SEVERITY AND SHORT-TERM OUTCOMES IN HFREF
Main Article Content
Keywords
heart failure, reduced ejection fraction, AST/ALT ratio, functional severity, prognosis
Abstract
Background
Heart failure with reduced ejection fraction (HFrEF) is a systemic syndrome that is frequently accompanied by hepatic congestion and dysfunction. Although natriuretic peptides are established prognostic biomarkers, their availability may be limited in certain clinical settings. Inexpensive and routinely measured liver-derived parameters may provide additional prognostic information. The aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio has been proposed as a potential marker of disease severity in heart failure; however, evidence in HFrEF remains limited.
Objective
To evaluate the association between AST/ALT ratio and functional severity as well as short-term prognostic indicators in patients with HFrEF.
Methods
This hospital-based observational study included 75 consecutive patients with HFrEF (left ventricular ejection fraction, <40%). The AST/ALT ratio was calculated at admission and categorised as <1 or ≥1. Functional severity was assessed using the New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF). Group comparisons, trend analysis across NYHA classes, correlation analysis, ordinal logistic regression, and receiver operating characteristic (ROC) curve analyses were performed.
Results
Patients with an AST/ALT ratio ≥1 were older and had significantly higher transaminase levels. A greater proportion of these patients were classified as NYHA class II–III. The AST/ALT ratio increased significantly with worsening NYHA class (P = 0.04). Ordinal logistic regression showed that the AST/ALT ratio independently predicted worse NYHA functional class (odds ratio 1.68, 95% confidence interval 1.02–2.78; P = 0.04). ROC analysis demonstrated moderate discriminatory ability for predicting NYHA ≥II (AUC 0.66) and NYHA functional class ≥III (AUC 0.69).
Conclusion
The AST/ALT ratio is associated with functional severity and short-term prognostic indicators in patients with HFrEF. Although not a standalone biomarker, it may serve as a practical adjunct for risk stratification when interpreted alongside conventional clinical assessments.
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Dr. VinothKhanna Gunasekaran
Associate Professor, Department of General Medicine, Government Thiruvarur Medical College, Thiruvarur, India.
Dr. K.Ram Kumar
Assistant Professor, Department of General Medicine, Government Thiruvarur Medical College, Thiruvarur, India
Dr.K.Sunthari
Assistant Professor, Department of General Medicine, Government Thiruvarur Medical College, Thiruvarur, India
Dr Mohamed Suhail A
Post Graduate, Department of General Medicine, Government Thiruvarur Medical College, Thiruvarur, India
Dr. J. B. Ashraf Ali
Associate Professor, Department of Physiology, Government Thiruvarur Medical College, Thiruvarur, India.
