Elevated AST/ALT (De Ritis) Ratio is a Risk Factor of Drainage Volume after Aortic Arch Surgery

BACKGROUND: To examine the correlation between the preoperative elevated aspartate aminotransferase (AST)/alanine transaminase (ALT) (De Ritis) ratio and the drainage volume in patients after aortic arch surgery. METHODS: This retrospective cohort study was conducted from January 2017 to December 2018. The exposure factor was the preoperative AST/ALT ratio and the primary outcome was the total amount of the drainage volume. The optimal AST/ALT ratio cutoff value was determined by the maximum Youden index. Accordingly, we defined the ratio ≥0.92 as a high AST/ALT ratio and <0.92 as a low AST/ALT ratio. Based on the median drainage volume of all participants, we dichotomized the study population: patients with a total drainage volume of 1670 mL or more were classified into high-output group (HOPG) and the remaining patients were classified into the low-output group (LOPG). Univariable and multivariable logistic regression analyses were conducted to investigate the correlation between the elevated AST/ALT ratio and drainage volume. RESULTS: 425 participants were enrolled. 213 participants were divided into the LOPG and the others were in the HOPG. 244 participants were divided into the low AST/ALT ratio group. In the univariable logistic regression analysis, the odds ratio (OR) and 95% condifence interval (CI) for the large drainage volume in participants with elevated AST/ALT ratio were 1.810 and 1.226-2.670 (p = 0.003). After adjustments with the confounders, multivariable logistic regression analysis showed an elevated AST/ALT ratio was significantly associated with the total amount of drainage volume (OR = 1.725, 95% CI 1.115-2.669, p = 0.014). CONCLUSIONS: Preoperative elevated AST/ALT ratio is an independent risk factor for the pericardial and mediastinal drainage volume in patients undergoing aortic arch surgery. It might represent a novel marker for individual risk assessment for cardiac surgery.