The Preoperative Uric Acid-to-Albumin Ratio as a New Indicator to Predict Long-Term Prognosis After Surgery for Patients with Acute Type A Aortic Dissection
DOI:
https://doi.org/10.1532/hsf.5087Keywords:
Acute aortic dissection; UAR Uric Acid-to-Albumin Ratio;serum albuminAbstract
Background: 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.
Methods and results: 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.
Conclusions: 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.
References
Abe N, Kashima Y, Izawa A, et al. 2015. A 2-year follow-up of oxidative stress levels in patients with ST-segment elevation myocardial infarction: a subanalysis of the ALPS-AMI study. Angiology. 66:271–7.
Arques S. 2018. Human serum albumin in cardiovascular diseases. Eur J Intern Med. Jun; 52:8–12.
Artigas A, Wernerman J, Arroyo V, et al. 2016. Role of albumin in diseases associated with severe systemic inflammation: pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis. J Crit Care. 33:62–70.
Balakumar P, Sharma R, Singh M. 2008. Benfotiamine attenuates nicotine and uric acid-induced vascular endothelial dysfunction in the rat. Pharmacol Res. 58(5/6): 356-363.
Cai J, Zhang Y, Zou J, et al. 2019. Serum uric acid could be served as an independent marker for increased risk and severity of ascending aortic dilatation in Behçet's disease patients. J Clin Lab Anal. 33(1):e22637.
Çakmak EÖ, Bayam E, Çelik M, et al. 2021. Uric Acid-to-Albumin Ratio: A Novel Marker for the Extent of Coronary Artery Disease in Patients with Non-ST-Elevated Myocardial Infarction. Pulse (Basel). 8(3-4):99-107.
Corry DB, Eslami P, Yamamoto K, et al. 2008. Uric acid stimulates vascular smooth muscle cell proliferation and oxidative stress via the vascular renin-angiotensin system. J Hypertens. 26(2):269–75.
Esen AM, Akcakoyun M, Esen O, et al. 2011. Uric acid as a marker of oxidative stress in dilatation of the ascending aorta. Am J Hypertens. 24(2):149–54.
Evangelista A, et al. 2018. Insights from the international registry of acute aortic dissection: A 20-year experience of collaborative clinical research. Circulation 137, 1846–1860.
Gao Y, Li D, Cao Y, et al. 2019. Prognostic value of serum albumin for patients with acute aortic dissection: A retrospective cohort study. Medicine (Baltimore). 98(6):e14486.
Hong Q, Qi K, Feng Z, et al. 2012. Hyperuricemia induces endothelial dysfunction via mitochondrial Na+ /Ca2+ exchanger-mediated mitochondrial calcium overload. Cell Calcium. 51(5): 402-410.
Kang DH, Park SK, Lee IK, et al. 2005. Uric acid-induced c-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol. 16(12): 3553-3562.
Keskin HA, Kurtul A, Esenboğa K, et al. 2021. Prognostic nutritional index predicts in-hospital mortality in patients with acute Stanford type A aortic dissection. Perfusion. 36(7):710-716.
Kleber ME, Delgado G, Grammer TB, et al. 2015. Uric acid and cardiovascular events: a mendelian randomization study. J Am Soc Nephrol. 26 (11):2831-2838.
Li DZ, Yu J, Du RS, et al. 2016. Thrombo-inflammatory status and prognosis of acute type A aortic dissection. Herz. 41:250–1.
Liao LZ, Zhang SZ, Li WD, Liu Y, Li JP, Zhuang XD, Liao XX. 2020. Serum albumin and atrial fibrillation: insights from epidemiological and Mendelian randomization studies. Eur J Epidemiol. 35:113–22.
Maruhashi T, Hisatome I, Kihara Y, et al. 2018. Hyperuricemia and endothelial function: From molecular background to clinical perspectives. Atherosclerosis. 278:226-231.
Mehta T, Nuccio E, McFann K, et al. 2015. Association of Uric Acid with Vascular Stiffness in the Framingham heart study. Am J Hypertens. 28(7):877–83.
Mercuro G, Vitale C, Cerquetani E, et al. 2004. Effect of hyperuricemia upon endothelial function in patients at increased cardiovascular risk. Am J Cardiol. 94(7):932–5.
Nagai T, Yoshikawa T, Saito Y, Takeishi Y, Yamamoto K, Ogawa H, Anzai T. 2018. JASPER Investigators. Clinical characteristics, management and outcomes of japanese patients hospitalized for heart failure with preserved ejection fraction –a report from the japanese heart failure syndrome with preserved ejection fraction (JASPER) registry. Circ J. 82:1534–45.
Pape LA, et al. 2007. Aortic Diameter ≥5.5 cm Is Not a Good Predictor of Type A Aortic Dissection: Observations From the International Registry of Acute Aortic Dissection (IRAD)[J]. Circulation. 116(10): 1120-1127.
Papezikova I, Pekarova M, Lojek A, et al. 2009. The effect of uric acid on homocysteine-induced endothelial dysfunction in bovine aortic endothelial cells. Neuro Endocrinol Lett. 30 Suppl 1:112-115.
Ronit A, Kirkegaard-Klitbo DM, Dohlmann TL, Lundgren J, Sabin CA, Phillips AN, Nordestgaard BG, Afzal S. 2020. Plasma albumin and incident cardiovascular disease: results from the CGPS and an updated meta-analysis. Arterioscler Thromb Vasc Biol. 40:473–82.
Ruggiero C, Cherubini A, Ble A, et al. 2006. Uric acid and inflammatory markers. Eur Heart J. 27(10):1174–81.
So A, Thorens B. 2010. Uric acid transport and disease. J Clin Invest. Jun;120(6):1791–9.
Tolis Jr S III. 2016. Contemporary insights into the management of type A aortic dissection. Expert Review of Cardiovascular Therapy. 14(10):1189-1196.
Trimarchi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Mehta RH,
Bossone E, Cooper JV, Smith DE, Menicanti L, Frigiola A, Oh JK, Deeb
MG, Isselbacher EM, Eagle KA. 2005. Contemporary results of surgery in acute
type A aortic dissection: the International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg. 129:112–122.
Virdis A, Masi S, Casiglia E, et al. 2020. Identification of the uric acid thresholds predicting an increased total and cardiovascular mortality over 20 years. Hypertension. 75(2):302-308.
Weiner J, Widman S, Golek Z, Tranquilli M, Elefteriades JA. 2011. Role of bovine serum albumin-glutaraldehyde glue in the formation of anastomatic pseudoaneurysms. J Card Surg. 26(1): 76-81.
Zeng R, Li D, Deng L, et al. 2016. Hypoalbuminemia predicts clinical outcome in patients with type B acute aortic dissection after endovascular therapy. Am J Emerg Med. 34:1369–72.
Zhang WJ, Frei B. 2002. Albumin selectively inhibits TNF alpha-induced expression of vascular cell adhesion molecule-1 in human aortic endothelial cells. Cardiovasc Res. Sep; 55(4):820–9.
Zhang Y, et al. 2020. Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection. Journal of Cardiothoracic Surgery. 15(3):112-122.
Zhao X, Bie M. 2020. Predictors for the development of preoperative oxygenation impairment in acute aortic dissection in hypertensive patients. BMC Cardiovasc Disord. 20(1): 365.
