{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T18:02:16Z","timestamp":1785261736466,"version":"3.55.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Simple biochemical markers that capture systemic stress could refine short-term risk stratification after TAVR. We evaluated whether an elevated AST\/ALT ratio predicts early adverse outcomes following transfemoral TAVR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 733 consecutive patients undergoing transfemoral TAVR. The exposure was the preprocedural AST\/ALT ratio categorized as low (&lt;1.4; n\u2009=\u2009478) or high (\u22651.4; n\u2009=\u2009255). Baseline characteristics were compared using t\/Wilcoxon tests and \u03c7\u00b2\/Fisher\u2019s exact tests. Thirty-day endpoints included all-cause mortality, acute kidney injury (AKI), stroke, and new-onset atrial fibrillation (NOAF). Kaplan\u2013Meier failure curves were compared by the log-rank test. Cox models estimated hazard ratios (HRs) with 95% CIs; candidate covariates were prespecified and further refined with LASSO (10-fold cross-validation). Model assumptions were checked with Schoenfeld residuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>High AST\/ALT was associated with greater 30-day risk of AKI (adjusted HR 3.18, 95% CI 1.80\u20135.63), stroke (adjusted HR 2.73, 95% CI 1.31\u20135.69), and NOAF (adjusted HR 2.35, 95% CI 1.57\u20133.51). For mortality, the crude association was not statistically significant (HR 2.07, 95% CI 0.91\u20134.68; p\u2009=\u20090.082) and remained non-significant after adjustment (HR 1.74, 95% CI 0.75\u20134.04; p\u2009=\u20090.197). Additional adjusted associations included higher AKI risk with high-intensity statins (HR 3.51, 95% CI 1.75\u20137.06) and baseline complete right bundle-branch block (HR 3.77, 95% CI 1.49\u20139.57).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An elevated preprocedural AST\/ALT ratio independently identifies TAVR recipients at increased 30-day risk of AKI, stroke, and NOAF, but not mortality. Incorporating this inexpensive marker into routine assessment may help tailor periprocedural strategies and early surveillance after TAVR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354267","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:43:07Z","timestamp":1785260587000},"page":"e0354267","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["De Ritis (AST\/ALT) ratio as a predictor of early adverse outcomes following transcatheter aortic valve replacement"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2336-3125","authenticated-orcid":true,"given":"Haitham","family":"Abu 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