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Introduction: the coronavirus (Covid-19), identified as the betacoronavirus genus, not only appears in the respiratory tract but can also appear in other organs such as the liver. The ratio of aspartate aminotransferase (AST) to alanine aminotransfarese (ALT) activity, known as the de Ritis ratio, can be used as a marker of liver dysfunction.

Objectives: the study aimed to evaluate the increment de Ritis ratio as a predictor of exacerbation of COVID-19.

Methods & Materials: This study was a retrospective cross-sectional study from April to November 2022. Ramelan Naval Hospital Center Surabaya, Dr Mohammad Soewandhie Surabaya Hospital, and Bhakti Rahayu Hospital Surabaya collected samples from 187 people with confirmed COVID-19.

Results: The median age of COVID-19 patients was 45.97 years, the length of hospital stay was 8, 67 days, and the de Ritis ratio was 1, 57. Spearman’s test for increment de Ritis ratio with the length of hospitalization for COVID-10 patients with r 0.11. Conversely, an increment of ratio de Ritis in discharge patients was found with r-0.52. Conclusion: Higher rates of de Ritis Ratio lead to longer hospital stays and higher mortality for COVID-19 patients