Prognostic value of the De Ritis ratio for 1-year major adverse cardiovascular events in elderly patients with acute decompensated heart failure

Background The De Ritis ratio, derived from serum aspartate aminotransferase and alanine aminotransferase levels, has shown prognostic value in cardiovascular diseases. Its role in elderly patients hospitalized with acute decompensated heart failure (ADHF) remains uncertain. Objectives To evaluate the prognostic value of the De Ritis ratio for 1-year major adverse cardiovascular events (MACEs) in elderly patients with ADHF. Methods A single-center, prospective cohort of 249 patients aged ≥65 years (median age 78, 53.8% female) hospitalized with ADHF was enrolled. Patients were categorized into tertiles by De Ritis ratio: <1.18 (n = 82), 1.18-1.49 (n = 88), and ≥l.49 (n = 79). The primary outcome was 1-year MACEs, including all-cause death, non-fatal myocardial infarction, stroke, and heart failure (HF) rehospitalization. Cox regression was used to identify independent predictors. Results At 1 year, 68 patients (27.3%) died and 150 (60.2%) experienced MACEs. The event rate increased progressively across tertiles: 31.7%, 64.8%, and 84.8% ( P < 0.001). The De Ritis ratio was significantly associated with age, diabetes mellitus, advanced HF symptoms, N-terminal pro-B-type natriuretic peptide, and reduced left ventricular ejection fraction. The optimal cutoff for predicting MACEs was 1.30 (C-statistic: 0.760, 95% confidence interval [CI]: 0.697-0.823, P < 0.001), with 78% sensitivity and 72.7% specificity. A De Ritis ratio >1.30 independently predicted outcomes (hazard ratio: 2.362; 95% CI: 1.536-3.634; P < 0.001). Conclusions An elevated De Ritis ratio is an independent predictor of 1-year MACEs in elderly patients with ADHF. This simple, accessible biomarker may aid clinical risk stratification.