Li Peiquan, Zhang Shaopeng, Chen Tongyun, Zhao Feng, Huang Boyu, Wang Jianyu, Jiang Nan, Bai Yunpeng, Chen Qingliang
Clinical School of Thoracic and Cardiovascular, Tianjin Medical University, Tianjin, China.
Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.
J Thorac Dis. 2024 Dec 31;16(12):8204-8215. doi: 10.21037/jtd-24-1383. Epub 2024 Dec 28.
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.
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.
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.
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.
卒中是急性A型主动脉夹层（ATAAD）患者术后严重并发症之一。本研究旨在探讨主动脉夹层行全弓置换加象鼻支架植入术患者术前血清尿酸与血清肌酐比值（SUA/Scr）与术后卒中的关系。
纳入2015年6月1日至2023年6月1日期间住院并接受手术、临床资料完整的ATAAD患者。收集术前SUA和Scr水平以计算SUA/Scr。采用单因素和多因素逻辑回归以及亚组分析来分析SUA/Scr与术后卒中的相关性。通过受试者工作特征（ROC）曲线分析确定SUA/Scr的最佳截断值。
本研究共纳入332例患者。发生术后卒中的患者SUA/Scr低于未发生卒中的患者（P=0.03）。单因素逻辑回归表明，较高的SUA/Scr与术后卒中风险降低相关[比值比（OR）=0.80；95%置信区间（CI）：0.65 - 0.98；P=0.03]。在调整混杂因素后，这种相关性仍然显著（OR =0.66；95% CI：0.45 - 0.97；P=0.04）。亚组分析显示，较高的SUA/Scr与术后卒中风险降低之间的相关性仅在男性患者（OR =0.81；95% CI：0.65 - 1.01；P=0.046）和年龄小于65岁的患者（OR =0.82；95% CI：0.66 - 1.02；P=0.048）中显著，并且仅在未行腋动脉插管（OR =0.65；95% CI：0.50 - 0.84；P=0.001）、左股动脉插管（OR =0.74；95% CI：0.58 - 0.96；P=0.02）和双侧脑灌注（OR =0.51；95% CI：0.32 - 0.81；P=0.004）的患者中观察到。ROC曲线分析确定SUA/Scr的最佳截断值为3.36。
较高的SUA/Scr与主动脉夹层行全弓置换加带支架象鼻植入术患者术后卒中风险降低相关，可能作为术后卒中的潜在预测指标。
