Is the serum creatinine/alanine transaminase ratio a predictor of mortality in elderly patients with acute ischemic stroke?

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Aims: In recent years, the rate of admission to intensive care in the elderly population has been increasing. We aimed to investigate the relationship between the serum creatinine/alanine transaminase ratio (sCr/ALT), which is thought to be a simpler method for predicting mortality in the elderly patient group instead of intensive care scoring systems that are difficult to calculate, and mortality. Methods: Medical records of patients treated in the intensive care unit due to acute ischemic stroke between January 2017 and October 2021 were evaluated. The study included 189 patients over the age of 85 who were diagnosed with cerebrovascular disease, had no known liver or kidney disease, and had a creatinine value of <1.5 mg/dl. APACHE II, SAPS II, and NIHSS scores calculated during admission to the intensive care unit were calculated from system data and patient records. Demographic data, additional diseases, hospital stay, laboratory values, sCr/ALT ratios and 28-day mortality status of the patients were recorded. Results: In a total of 189 patients, 66 male and 123 female, included in the study, mortality occurred at a rate of 65.1% (n: 123) in the first 28 days. The presence of coronary artery disease (p=0.044) was significantly higher in mortal cases. There were statistically significant differences in APACHE II score (p<0.001), SAPS II (p<0.001), AST (p=0.008), creatinine (p<0.001), sCr/ALT ratio (p<0.001), neutrophil/lymphocyte ratio (p=0.049), ferritin (p=0.003) and CRP (p=0.006) in mortal cases and non-mortals. In mortal cases, NIHSS severe (p<0.001) percentage was significantly higher than in other patients. ALT (p<0.001), lymphocyte (p=0.009) and albumin (p<0.001) values were statistically significantly lower in mortal cases than in non-mortals. When we evaluated the 28-day mortality prediction performances of the variables, the sCr/ALT ratio was found to have 85.4% sensitivity and 84.8% specificity, the albumin value had 85.4% sensitivity and 60.6% specificity, and the APACHE II score had 61.8% sensitivity and 90.9% specificity . Conclusion: NIHSS, APACHI II and SAPS II are used as mortality and disease severity indicators in elderly intensive care patients with acute ischemic stroke. When compared with these scores, the sCr/ALT value is a valuable indicator in predicting mortality. We found that the sCr/ALT ratio, which is easily worked on and calculated in many centers, can better predict mortality in elderly patients with ischemic stroke.

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