Dynamic Changes of De Ritis Ratio in Pediatric Lobar Pneumonia and Their Relationship With Disease Severity

Aims/Background: Lobar pneumonia (LP) remains a significant cause of morbidity in children. Early and accurate assessment of the disease severity is crucial for optimal management, yet readily available and specific biomarkers are lacking. This study aimed to analyze the dynamic changes of aspartate aminotransferase/alanine aminotransferase (De Ritis) ratio in children with LP, and to explore their relationship with the disease severity. Methods: A total of 120 children with LP admitted to the Affiliated Hospital of Xuzhou Medical University from June 2020 to June 2025 were divided into a common pneumonia group (n = 69) and a severe pneumonia group (n = 51) according to the severity of the disease. Hierarchical multiple linear regression was used to analyze the effects of baseline De Ritis ratio, gender, age, body mass index (BMI) and pulmonary lobe lesions on the ΔDe Ritis ratio before treatment and 14 days after treatment. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic efficacy of De Ritis ratio in children with LP before treatment. The dose–response relationship between De Ritis ratio and the condition of LP children was analyzed using a restricted cubic spline. The clinical decision curve was used to analyze the diagnostic efficacy of De Ritis ratio in children with LP. Results: Repeated measures analysis of variance showed that the De Ritis ratio had significant time effect, between-group effect and time–group interaction effect (all p < 0.001). The De Ritis ratio of the two groups decreased significantly with treatment, with the decline (ΔDe Ritis ratio) being significantly higher in the severe pneumonia group than in the common pneumonia group at each time point (p < 0.05). The results of hierarchical multiple linear regression showed that baseline De Ritis ratio (β < 0), gender, age, BMI and lobar lesions (all β > 0) had a significant effect on De Ritis ratio (p < 0.05). The area under the curve (AUC) for the De Ritis ratio was 0.908, with an optimal cutoff value of 1.52. The restricted cubic spline analysis revealed a non-linear dose-response relationship between De Ritis ratio and LP (pnonlinear < 0.001). According to the clinical decision curve analysis, De Ritis ratio demonstrated substantial clinical utility in the diagnosis of LP. Conclusion: De Ritis ratio possesses significant clinical value in the evaluation of LP and its dynamic alterations show a consistent relationship with the severity of the condition.