The AST/ALT (De Ritis) ratio as a significant prognostic factor in myelodysplastic syndrome

Background: The aspartate transaminase (AST)/alanine transaminase (ALT) ratio, also termed the De Ritis ratio, has been demonstrated to have an association with poor prognosis in several cancer types. However, its prognostic value in patients with myelodysplastic syndrome (MDS) remains unclear. Methods: A total of 265 MDS patients were divided into two groups by R. The clinical, laboratory, and follow-up data of patients with MDS were collected, while the relationship between AST/ALT ratio and overall survival (OS) and leukemia-free survival (LFS) were also analyzed. Results: The results showed that higher AST/ALT ratio was associated with higher age, β2-microglobulin level, and number of co-mutations (>4). Moreover, the high AST/ALT group had a significantly shorter OS and LFS than the low AST/ALT group. Multivariate analysis involving the Revised International Prognostic Scoring System (IPSS-R) showed that a higher AST/ALT ratio was an independent adverse factor for OS or LFS; however, the same was not noted in the multivariate analysis involving the new Molecular International Prognostic Scoring System (IPSS-M). Conclusions: Our study suggests that the AST/ALT ratio could be a simple and economic prognostic indicator for MDS and be used as a supplement to IPSS-R, especially when lacking of karyotype or mutation data.