Relation between uric acid and stroke in aortic dissection.

BACKGROUND

Stroke is one of the severe complications following surgery in patients with acute type A aortic dissection (ATAAD). This study investigates the relationship between the preoperative serum uric acid to serum creatinine ratio (SUA/Scr) and postoperative stroke in patients undergoing total arch replacement with elephant trunk implantation for aortic dissection.

METHODS

We included ATAAD patients who were hospitalized and underwent surgery between June 1, 2015 and June 1, 2023, with complete clinical information. Preoperative SUA and Scr levels were collected to calculate SUA/Scr. The association between SUA/Scr and postoperative stroke was analyzed using univariate and multivariate logistic regression, as well as subgroup analysis. The optimal cut-off value of SUA/Scr was determined by receiver operating characteristic (ROC) curve analysis.

RESULTS

A total of 332 patients were included in the study. Patients who developed postoperative stroke had lower SUA/Scr compared to those who did not (P=0.03). Univariate logistic regression indicated that higher SUA/Scr was associated with a reduced risk of postoperative stroke [odds ratio (OR) =0.80; 95% confidence interval (CI): 0.65-0.98; P=0.03]. This association remained significant after adjusting for confounding factors (OR =0.66; 95% CI: 0.45-0.97; P=0.04). Subgroup analysis revealed that the association between higher SUA/Scr and reduced risk of postoperative stroke was significant only in male patients (OR =0.81; 95% CI: 0.65-1.01; P=0.046) and those younger than 65 years (OR =0.82; 95% CI: 0.66-1.02; P=0.048), and was observed only in patients who underwent non-axillary artery cannulation (OR =0.65; 95% CI: 0.50-0.84; P=0.001), left femoral artery cannulation (OR =0.74; 95% CI: 0.58-0.96; P=0.02), and bilateral cerebral perfusion (OR =0.51; 95% CI: 0.32-0.81; P=0.004). The ROC curve analysis identified 3.36 as the optimal cut-off value for SUA/Scr.

CONCLUSIONS

A higher SUA/Scr is associated with a reduced risk of postoperative stroke in patients with aortic dissection undergoing total arch replacement with stented elephant trunk implantation and may serve as a potential predictor of postoperative stroke.