Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, 100020 Beijing, China.
Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Science, Peking Union Medical College, 100037 Beijing, China.
Heart Surg Forum. 2023 Dec 18;26(6):E755-E763. doi: 10.59958/hsf.6933.
To examine the correlation between the preoperative elevated aspartate aminotransferase (AST)/alanine transaminase (ALT) (De Ritis) ratio and the drainage volume in patients after aortic arch surgery.
This retrospective cohort study was conducted from January 2017 to December 2018. The exposure factor was the preoperative AST/ALT ratio and the primary outcome was the total amount of the drainage volume. The optimal AST/ALT ratio cutoff value was determined by the maximum Youden index. Accordingly, we defined the ratio ≥0.92 as a high AST/ALT ratio and <0.92 as a low AST/ALT ratio. Based on the median drainage volume of all participants, we dichotomized the study population: patients with a total drainage volume of 1670 mL or more were classified into high-output group (HOPG) and the remaining patients were classified into the low-output group (LOPG). Univariable and multivariable logistic regression analyses were conducted to investigate the correlation between the elevated AST/ALT ratio and drainage volume.
425 participants were enrolled. 213 participants were divided into the LOPG and the others were in the HOPG. 244 participants were divided into the low AST/ALT ratio group. In the univariable logistic regression analysis, the odds ratio (OR) and 95% condifence interval (CI) for the large drainage volume in participants with elevated AST/ALT ratio were 1.810 and 1.226-2.670 (p = 0.003). After adjustments with the confounders, multivariable logistic regression analysis showed an elevated AST/ALT ratio was significantly associated with the total amount of drainage volume (OR = 1.725, 95% CI 1.115-2.669, p = 0.014).
Preoperative elevated AST/ALT ratio is an independent risk factor for the pericardial and mediastinal drainage volume in patients undergoing aortic arch surgery. It might represent a novel marker for individual risk assessment for cardiac surgery.
研究主动脉弓手术后患者术前天门冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）（De Ritis）比值升高与引流总量的相关性。
这是一项回顾性队列研究，于 2017 年 1 月至 2018 年 12 月进行。暴露因素为术前 AST/ALT 比值，主要结局为引流总量。通过最大 Youden 指数确定最佳 AST/ALT 比值截断值。相应地，我们将比值≥0.92 定义为高 AST/ALT 比值，<0.92 定义为低 AST/ALT 比值。根据所有参与者的中位引流总量，将研究人群分为两组：引流总量≥1670ml 者归入高输出组（HOPG），其余归入低输出组（LOPG）。采用单变量和多变量逻辑回归分析探讨升高的 AST/ALT 比值与引流量之间的相关性。
共纳入 425 名患者。其中 213 名患者归入 LOPG，其余归入 HOPG。244 名患者归入低 AST/ALT 比值组。单变量逻辑回归分析显示，AST/ALT 比值升高患者的大引流量比值比（OR）及其 95%置信区间（CI）为 1.810（1.226-2.670，p=0.003）。经混杂因素校正后，多变量逻辑回归分析显示，AST/ALT 比值升高与总引流量显著相关（OR=1.725，95%CI 1.115-2.669，p=0.014）。
术前 AST/ALT 比值升高是主动脉弓手术患者心包和纵隔引流总量的独立危险因素。它可能代表心脏手术个体风险评估的一个新标志物。
