CLINICAL UTILITY OF THE ALT/LDH RATIO IN PREDICTING OUTCOMES OF ACUTE LIVER INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Acute liver injury (ALI) is a critical condition associated with high morbidity and mortality. The early identification of patients at risk of severe outcomes is essential for timely intervention. The ALT/LDH ratio has been suggested as a potential prognostic marker in predicting the severity and outcomes of ALI. This systematic review and meta-analysis aims to evaluate the effectiveness of the ALT/LDH ratio in predicting poor clinical outcomes in patients with ALI. Methods: We conducted a systematic review and meta-analysis of studies published from 2000 to 2025 that investigated the association between the ALT/LDH ratio and clinical outcomes in patients with ALI. A total of 20 studies were included, comprising observational cohort and cross-sectional studies. The primary outcomes evaluated were liver failure, mortality, and other complications. Effect sizes (Cohen's d), p-values, and 95% confidence intervals (CIs) were calculated to assess the relationship between the ALT/LDH ratio and these outcomes. Results: The meta-analysis revealed a moderate to strong association between the ALT/LDH ratio and poor outcomes in ALI patients. The pooled effect size (Cohen’s d) was 0.72, indicating a significant correlation between higher ALT/LDH ratios and the severity of liver injury. The ALT/LDH ratio was found to be a statistically significant predictor of liver failure (p < 0.05) and mortality (p < 0.05) across multiple studies. The 95% confidence intervals for the effect sizes ranged from 0.20 to 1.08, suggesting variability in the strength of the association between studies. Conclusions: This systematic review and meta-analysis support the ALT/LDH ratio as a reliable prognostic marker for predicting the severity and outcomes of acute liver injury. Higher ALT/LDH ratios were significantly associated with an increased risk of liver failure and mortality. However, further large-scale, multicenter studies with standardized protocols are necessary to validate these findings and establish definitive clinical guidelines for the use of the ALT/LDH ratio in clinical practice.