An increase of the de Ritis ratio (dRR), the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), is known as a marker of liver fibrosis and cirrhosis (Botros M, Sikaris KA; 2013), as well as a predictor of mortality in patients after cardiac arrest and after myocardial infarction (Steininger M et al.; 2018), but is not sufficiently studied in patients with metabolic-associated liver steatosis (MALS).

Aim: to determine de Ritis ratio in patients with a cardiorheumatic diseases associated with liver steatosis. 243 patients were examined (coronary artery disease (CAD), unstable angina (UA) 104; stable angina (SA) 75; acute rheumatic fever (ARF) 58; chronic rheumatic heart disease (CRHD) with valvular defects 44; hemorrhagic vasculitis (HV) 50). They were divided into 2 groups with MALS (UA 87; SA 56; ARF 31; CRHD 32; HV 31) and with intact liver. The results were processed statistically.

Results and discussion. In cardiorheumatic patients with MALS the value of dRR ranged from 0.71±0.05 in patients with acute forms of coronary artery disease to 1.28±0.09 mmol/h/l in patients with CRHD. In patients with liver steatosis, dRR was lower than in persons with an intact liver (CAD, UA: 0.71±0.05 vs. 0.95±0.05 mmol/h/l; p<0.05) due to a predominant increase in ALT activity, which is the first sign of hepatocytes apoptosis and was most clearly expressed in patients with acute and chronic forms of CAD and acute forms of rheumatic diseases (ARF, HV). According to correlation analysis, ALT activation was associated with systemic inflammation activation, increased lipid distress-syndrome, glucose intolerance and features of myocardial hypertrophy. Conclusion. In cardiorheumatic patients metabolic-associated liver steatosis was accompanied by a lower level of de Ritis ratio in comparison with intact liver due to some ALT activation in normal range.

Article received: 16.12.2022

Keywords: liver steatosis, de Ritis ratio, alanine aminotransferase, coronary artery disease

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