Association of De Ritis ratio with mortality in ICU patients with sepsis-associated acute kidney injury: a retrospective multicenter cohort study

BACKGROUND: Sepsis-associated acute kidney injury (SA-AKI) is associated with adverse clinical outcomes. The De Ritis ratio (AST/ALT) has been studied as a biomarker for various diseases; however, its relationship with mortality in intensive care unit (ICU) patients with SA-AKI remains unclear. METHODS: This multicenter retrospective cohort study used data from Medical Information Mart for Intensive Care IV (MIMIC-IV) database and eICU Collaborative Research Database (eICU-CRD). The Boruta algorithm, Kaplan-Meier method, and Cox proportional hazards model was used for the analysis. RESULTS: A total of 24,468 patients were included. The De Ritis ratio was significantly higher in deceased patients. The Boruta algorithm identifies it as an important predictor of mortality. Kaplan-Meier analysis showed higher mortality in the groups with elevated De Ritis ratios. Cox analysis indicated that it was a significant risk factor for mortality, with nonlinear associations found using RCS. CONCLUSION: The De Ritis ratio is a significant and independent predictor of mortality in ICU patients with SA-AKI, highlighting its potential clinical utility in assessing prognosis and aiding in treatment decisions. Further prospective studies are required to confirm these findings.