The Clinical Value of the AST-to-ALT Ratio in Predicting Severity, Complications, and Prognosis in Acute Pancreatitis.

Introduction: The aspartate aminotransferase-to-alanine aminotransferase (AST/ALT) ratio has been widely recognized as an indicator of disease severity, complications, and prognosis in various clinical conditions. However, its relevance in acute pancreatitis (AP) has not yet been clearly established. This study is aimed at systematically evaluating the association between the AST/ALT ratio and AP, with a focus on disease severity, complication rates, and clinical outcomes. Methods: A retrospective analysis was conducted on patients diagnosed with AP at the First Affiliated Hospital of Guangdong Pharmaceutical University between July 2014 and December 2020. Multivariate logistic regression and linear regression were used to examine the relationship between the AST/ALT ratio and AP severity, complications, and prognosis. Results: A total of 207 patients were enrolled. Based on the optimal AST/ALT cut-off value determined by receiver operating characteristic curve analysis, patients were categorized into high and low AST/ALT groups. Elevated AST/ALT ratios were independently associated with severe AP, higher incidences of complications such as pleural effusion, acute heart failure, acute kidney failure, and systemic inflammatory response syndrome, as well as worse clinical outcomes, including greater vasopressor use. Linear regression further demonstrated a significant correlation between the AST/ALT ratio and severity scoring systems, including MODS, APACHE II, and Ranson scores. Conclusion: An elevated AST/ALT ratio is a strong predictor of increased disease severity, higher complication risk, and poorer prognosis in patients with AP. The AST/ALT ratio may serve as a simple, cost-effective, and sensitive biomarker for early assessment of AP progression and outcomes.