Maeda D, Sakane K, Kanzaki Y, et al. - Among 774 patients with acute heart failure (AHF), this inquiry was performed to examine the link between aspartate aminotransferase to alanine aminotransferase ratio (AAR) and nutritional status and prognosis. Based on AAR at discharge, three groups of patients were defined: first tertile, AAR < 1.16 (n = 262); second tertile, 1.16 ≤ AAR < 1.70 (n = 257); and third tertile, AAR ≥ 1.70 (n = 255). A link was seen between a higher AAR and worse nutritional indices (ie, controlling nutritional status score, geriatric nutritional risk index and prognostic nutritional index). Along AAR tertiles, a significant increase in clinical outcome rates was evident. In Cox proportional hazards models incorporating potential prognostic factors, high AAR was identified as an independent prognostic factor of AHF. Overall, in patients with AHF, a likely association of AAR at discharge with nutritional status as well as with worse clinical outcomes was indicated.