The reversed De Ritis ratio for predicting in-hospital mortality among intensive care patients with organophosphate poisoning

Abstract

Introduction

The uncontrolled use of pesticides signifies a substantial health hazard. This study was designed to explore the prognostic role of on-admission hepatic aminotransferases [alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the reversed De Ritis ratio (ALT/AST)] in the prediction of in-hospital mortality among patients with acute organophosphate (OP) poisoning.

Patients and methods

We conducted a retrospective study based on extracting the required information from the specific medical records for acutely OP-intoxicated patients admitted to the intensive care unit.

Results

A total of 49 acutely malathion-intoxicated patients were enrolled in the study. The in-hospital mortality rate was 32.7%. Patients were stratified into survivors and non-survivors. Compared to the survivors, the non-survivors had significantly lower Glasgow coma scale scores, mean arterial blood pressure, significantly higher reversed De Ritis ratio (ALT/AST), and ALT and AST activities. The reversed De Ritis ratio (ALT/AST) and ALT demonstrated good discrimination between the survivors and the non-survivors with an area under the curve (AUC) of 0.708 vs 0.781, respectively, however, AST showed satisfactory discrimination, AUC of 0.694.

Conclusion

Hepatic aminotransferases are useful in predicting in-hospital mortality in acute OP poisoning. ALT is the most specific biomarker. However, the reversed De Ritis ratio (ALT/AST) is the most sensitive one.

Keywords:

• Alanine aminotransferase
• aspartate aminotransferase
• mortality prediction
• organophosphate poisoning
• reversed De Ritis ratio

Authors’ contributions

ON conceived the study, performed data analysis, and wrote the original draft. WGA shared the study design, data collection, and writing the original draft. All authors contributed to drafting, and revising the article, approved the final version, and agreed to be accountable for all aspects of the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Data availability statement

Data are available from the corresponding author upon reasonable request.