Liu Siyuan, Wang Binbin, Ma Libin, Yang Huikai, Liu Min, Song Yuxiang, Zhou Zhikang, Lou Jingsheng, Zhou Daming, Cao Jiangbei, Liu Yanhong, Mi Weidong, Ma Yulong
Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
CNS Neurosci Ther. 2025 Jan;31(1):e70223. doi: 10.1111/cns.70223.
Patients with diabetes are at a high risk for perioperative ischemic stroke (PIS). The use of biomarkers to identify high-risk patients and predict PIS may provide considerable reference value in clinical decision-making. The aspartate transaminase/alanine transaminase ratio (De Ritis ratio) has been proven to be associated with specific diabetic complications. However, the association between the De Ritis ratio and PIS has not been evaluated in this population. This retrospective cohort study aimed to evaluate the association between the preoperative De Ritis ratio and PIS in patients with type 2 diabetes undergoing noncardiovascular surgery.
Data from surgical patients were collected from January 2008 to August 2019. A total of 27,643 patients with type 2 diabetes mellitus (DM) undergoing noncardiovascular surgery under general anesthesia were screened. The optimal De Ritis ratio cutoff value was identified using the receiver operating characteristic (ROC) curve. Logistic regression models were used to evaluate the association between the preoperative De Ritis ratio and PIS. Propensity score matching (PSM), sensitivity analyses, and subgroup analyses were performed to further validate the robustness of this association.
A total of 151 patients experienced PIS. A De Ritis ratio ≥ 1.04 was associated with an elevated risk of PIS after adjusting for baseline characteristics (OR [95% CI]: 2.25 [1.59-3.21]; p < 0.001), intraoperative parameters (2.50 [1.80-3.49]; p < 0.001), and all confounding variables (2.29 [1.61-3.29]; p < 0.001). In the propensity score-matched cohort, the association between the De Ritis ratio and PIS remained significant (2.04 [1.38-3.05]; p < 0.001). These associations were also consistently maintained in the sensitivity and subgroup analyses.
An elevated De Ritis ratio is strongly associated with a higher risk of PIS in patients with type 2 DM undergoing noncardiovascular surgery. This may provide additional information on PIS risk assessment in patients with type 2 DM undergoing noncardiovascular surgery.
糖尿病患者围手术期缺血性卒中（PIS）风险较高。使用生物标志物识别高危患者并预测PIS可能为临床决策提供重要参考价值。天冬氨酸转氨酶/丙氨酸转氨酶比值（德瑞蒂斯比值）已被证明与特定糖尿病并发症相关。然而，该人群中德瑞蒂斯比值与PIS之间的关联尚未得到评估。这项回顾性队列研究旨在评估2型糖尿病患者接受非心血管手术时术前德瑞蒂斯比值与PIS之间的关联。
收集2008年1月至2019年8月手术患者的数据。共筛选出27643例接受全身麻醉下非心血管手术的2型糖尿病（DM）患者。使用受试者工作特征（ROC）曲线确定德瑞蒂斯比值的最佳临界值。采用逻辑回归模型评估术前德瑞蒂斯比值与PIS之间的关联。进行倾向评分匹配（PSM）、敏感性分析和亚组分析以进一步验证这种关联的稳健性。
共有151例患者发生PIS。在调整基线特征（OR[95%CI]：2.25[1.59 - 3.21]；p<0.001）、术中参数（2.50[1.80 - 3.49]；p<0.001）和所有混杂变量（2.29[1.61 - 3.29]；p<0.001）后，德瑞蒂斯比值≥1.04与PIS风险升高相关。在倾向评分匹配队列中，德瑞蒂斯比值与PIS之间的关联仍然显著（2.04[1.38 - 3.05]；p<0.001）。这些关联在敏感性和亚组分析中也持续存在。
德瑞蒂斯比值升高与2型糖尿病患者接受非心血管手术时发生PIS的较高风险密切相关。这可能为2型糖尿病患者接受非心血管手术时的PIS风险评估提供额外信息。
