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Abstract：
The study aimed to assess the predictive value of blood urea nitrogen (BUN)-to-albumin ratio (BA-R) for in-hospital mortality in patients undergoing emergency surgery for acute type A aortic dissection (ATAAD). Patients who were diagnosed with ATAAD and underwent emergency surgery within 48 hours of onset at our hospital between January 2015 and December 2021 were included in this study. The primary endpoint of this study was postoperative in-hospital mortality (POIM). The data of the survivors and non-survivors were retrospectively compared analyses. A total of 557 ATAAD patients were included, with 505 survivors and 52 non-survivors. The preoperative BA-R of the non-survivor group was significantly higher than that of the survivor group (P < 0.001). Univariate regression analysis showed that preoperative BA-R, serum creatinine level, SA level, D-dimer level, age, myocardial ischemia, cerebral ischemia, and aortic clamp time were risk factors for POIM. In addition, multivariable regression analysis showed that preoperative BA-R ≥ 0.155 mmol/g was a risk factor for POIM (odds ratio, 6.815 [3.582-12.964]; P < 0.001). Receiver operating characteristic curve indicated that the cut-off point for preoperative BA-R was ≥0.155 mmol/g (area under the curve =0.874). The sensitivity and specificity of preoperative BA-R in predicting the POIM of patients who underwent emergency surgery for ATAAD were 84.6% and 71.3%, respectively (95% confidence interval, 0.829-0.919; P < 0.001). In conclusion, Preoperative BA-R is a simple, rapid, and potentially useful prognostic indicator of POIM in patients with ATAAD. BAR: Blood urea nitrogen-to-albumin ratio, BUN: Blood urea nitrogen, SA: Serum albumin, REF: Reference. The aim of this study was to evaluate the prognostic value of BA-R for the prediction of postoperative in-hospital mortality in patients who underwent emergency surgery for ATAAD. A total of 557 patients with ATAAD were enrolled, and 505 survived while 52 did not. The preoperative BA-R of the non-survivor group was significantly higher than that of the survivor group (0.27 [0.18, 0.46] vs. 0.12 [0.10, 0.16]mmol/g; P < 0.001). The study showed that preoperative BA-R ≥ 0.155 mmol/g was a risk factor for POIM (odds ratio, 6.815 [3.582-12.964]; P < 0.001). ROC curve indicated that the cut-off point for preoperative BA-R was ≥0.155 mmol/g (AUC = 0.874) and the sensitivity and specificity were 84.6% and 71.3%, respectively (95% CI, 0.829-0.919; P < 0.001). We believe that our study makes a significant contribution to the literature because we found preoperative BA-R to be a simple, rapid, and potentially useful prognostic indicator of postoperative in-hospital mortality in patients with ATAAD.
摘要：
该研究旨在评估尿素氮（BUN）与白蛋白之比（BA-R）对接受急性A型主动脉夹层（ATAAD）急诊手术的患者院内死亡率的预测价值。这项研究包括2015年1月至2021年12月在我们医院诊断为ATAAD并在发病后48小时内接受急诊手术的患者。这项研究的主要终点是术后院内死亡率（POIM）。对幸存者和非幸存者的数据进行回顾性比较分析。共纳入557名ATAAD患者，505名幸存者和52名非幸存者。非存活组术前BA-R显著高于存活组(P<0.001)。单因素回归分析显示,术前BA-R,血清肌酐水平，SA等级,D-二聚体水平,年龄,心肌缺血,脑缺血,主动脉钳夹时间是POIM的危险因素。此外,多因素回归分析显示,术前BA-R≥0.155mmol/g是POIM的危险因素(比值比,6.815[3.582-12.964]；P<0.001）。受试者工作特征曲线显示术前BA-R的临界点≥0.155mmol/g(曲线下面积=0.874)。术前BA-R预测ATAAD急诊手术患者POIM的敏感性和特异性分别为84.6%和71.3%,分别(95%置信区间，0.829-0.919；P<0.001）。总之,术前BA-R是一个简单的，快速,以及ATAAD患者POIM的潜在有用预后指标。BAR：血尿素氮与白蛋白之比，BUN:血尿素氮,SA：血清白蛋白，参考：参考。这项研究的目的是评估BA-R对接受ATAAD急诊手术的患者术后院内死亡率的预测价值。共纳入557例ATAAD患者，505人幸存，52人没有。非幸存者组术前BA-R显著高于幸存者组(0.27[0.18,0.46]vs.0.12[0.10,0.16]mmol/g;P<0.001)。研究表明，术前BA-R≥0.155mmol/g是POIM的危险因素(比值比，6.815[3.582-12.964]；P<0.001）。ROC曲线显示术前BA-R的分界点≥0.155mmol/g(AUC=0.874)，敏感性和特异性分别为84.6%和71.3%。分别为(95%CI，0.829-0.919；P<0.001)。我们相信我们的研究对文献做出了重大贡献，因为我们发现术前BA-R是一个简单的，快速,以及ATAAD患者术后院内死亡率的潜在有用预后指标。
