Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China.
Department of Emergency Internal Medicine, Shaanxi Provincial People's Hospital, Xi'an, P.R. China.
Heart Surg Forum. 2023 Jan 9;26(1):E001-E008. doi: 10.1532/hsf.5087.
The long-term prognosis of patients with acute type A aortic dissection (AAD) is poor, despite emergency surgical treatment. Therefore, it is imperative to evaluate patient risk factors to improve the prognosis. The aim of this study was to analyze the ability of the uric acid-to-albumin ratio (UAR) to predict the long-term mortality of patients with type A AAD after surgery.
A total of 289 patients with type A AAD who had received surgical treatment was enrolled in this study. Peripheral blood samples were collected before anesthesia induction. All patients were divided into the UAR < 9.875 group and the UAR ≥ 9.875 group, and mortality significantly differed between the two groups. The patients were further divided into survival and non-survival groups, according to whether death occurred after the procedure based on a one-year follow up. Factors, including age, hypertension, albumin, UAR, and D-dimer, differed significantly between the survival and non-survival groups. The independent risk factors for long-term death in patients with type A AAD were analyzed by univariable and multivariable COX regression analyses, and the predictive value of these indices for postoperative mortality was assessed based on the receiver operating characteristic (ROC) curves. Preoperative UAR (HR 1.904, 95% CI, 1.097 to 3.305; P < 0.05), D-dimer (HR, 1.991,95% CI, 1.116 to 3.554; P < 0.05 ), and age (HR 2.216, 95% CI, 1.287 to 3.815; P < 0.05) were identified as independent risk factors for one-year mortality in patients with Type A AAD. The area under the ROC curve (AUC) of UAR was 0.618 [95% (0.544, 0.693)], and the sensitivity and specificity were 69.6% and 51.8%, respectively (P = 0.003). The AUC for albumin was 0.349 [95% (0.274, 0.425)], and the sensitivity and specificity were 26.1% and 51.8%, respectively (P = 0.000), The AUC for uric acid was 0.544 [95% (0.470, 0.619)], and the sensitivity and specificity were 78.3% and 34.5%, respectively (P = 0.265). The AUC for UAR + age + D-dimer was 0.751 [95% (0.681, 0.821)], and the sensitivity and specificity were 76.8% and 68.2%, respectively.
UAR in patients with type A AAD may be used as a new independent risk factor for long-term mortality. Its predictive value is superior to that of albumin or uric acid alone. The combination of UAR, age, and D-dimer provide good prognostic value.
尽管进行了紧急外科治疗，急性 A 型主动脉夹层（AAD）患者的长期预后仍不佳。因此，评估患者的风险因素以改善预后至关重要。本研究旨在分析尿酸-白蛋白比值（UAR）预测 A 型 AAD 患者手术后长期死亡率的能力。
共纳入 289 例接受手术治疗的 A 型 AAD 患者。在麻醉诱导前采集外周血样本。所有患者均分为 UAR<9.875 组和 UAR≥9.875 组，两组死亡率差异有统计学意义。根据术后 1 年的随访结果，将患者进一步分为存活组和非存活组。根据是否死亡，将存活和非存活组之间的年龄、高血压、白蛋白、UAR 和 D-二聚体等因素进行比较。通过单变量和多变量 COX 回归分析确定 A 型 AAD 患者长期死亡的独立危险因素，并根据受试者工作特征（ROC）曲线评估这些指标对术后死亡率的预测价值。术前 UAR（HR 1.904，95%CI，1.097 至 3.305；P<0.05）、D-二聚体（HR，1.991，95%CI，1.116 至 3.554；P<0.05）和年龄（HR 2.216，95%CI，1.287 至 3.815；P<0.05）是 A 型 AAD 患者 1 年死亡率的独立危险因素。UAR 的 ROC 曲线下面积（AUC）为 0.618[95%（0.544，0.693）]，灵敏度和特异度分别为 69.6%和 51.8%（P=0.003）。白蛋白的 AUC 为 0.349[95%（0.274，0.425）]，灵敏度和特异度分别为 26.1%和 51.8%（P=0.000），尿酸的 AUC 为 0.544[95%（0.470，0.619）]，灵敏度和特异度分别为 78.3%和 34.5%（P=0.265）。UAR+年龄+D-二聚体的 AUC 为 0.751[95%（0.681，0.821）]，灵敏度和特异度分别为 76.8%和 68.2%。
A 型 AAD 患者的 UAR 可作为长期死亡率的新独立危险因素。其预测价值优于白蛋白或尿酸单独使用。UAR、年龄和 D-二聚体的组合提供了良好的预后价值。
