Is AST/ALT Ratio a Predictor of In-hospital Mortality in Pulmonary Embolism Patients?

Objective: To document the association between serum transaminases and in-hospital mortality in pulmonary embolism (PE) patients. Study Design: Analytical study. Place and Duration of Study: Patients treated with acute PE in hospital between January 2011 and December 2019 from Sakarya University Medical School Research and Teaching Hospital, Sakarya, Turkey. Methodology: Patients with PE were included. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value for AST/ALT ratio to predict in-hospital death. Simplified pulmonary embolism severity index (sPESI) scores were calculated and the AST/ALT ratio were entered into binary logistic regression analysis with components of sPESI score to document the prognostic significance of as an independent predictor of in-hospital mortality. Results: 164 acute PE patients were included; of those, 33 (20%) died in hospital. Deceased patients had higher AST/ALT ratio (median, 1.4; 25th-75th percentile, 1.1-1.8) comparing to patients with discharged home (median, 1.1; 25th-75th percentile, 0.84-1.4) (p=0.006). ROC analysis showed that AST/ALT ratio was an indicator of in-hospital mortality, and the calculated area under the curve was 0.655 (95% CI, 0.547-0.764). The cut-off value of 1.3 was associated with a prognostic sensitivity of 61% and specificity of 65%. Binary logistic regression analysis failed to show AST/ALT ratio as an independent predictor of in-hospital mortality. Conclusion: AST/ALT ratio predicts in-hospital mortality with acceptable sensitivity and specificity in patients with acute PE and might be used as a biomarker for risk stratification.