Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection
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(2020) 15:21
RESEARCH ARTICLE
Open Access
Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection Yiran Zhang, Xingjie Xu, Yuan Lu, Lei Guo and Liang Ma*
Abstract Background: The present study aimed to evaluate the value of admission serum uric acid (UA) level in predicting in-hospital risk of death in patients with acute type A aortic dissection (AAAD). Methods: From January 2016 to June 2019, 186 consecutive patients with AAAD who underwent thoracic aortic surgery were retrospectively studied. Serum UA levels were measured on admission. Forward conditional logistic regression was performed to identify independent risk factors for in-hospital death. Receiver operating characteristic (ROC) analysis was performed to assess the most clinical useful level of serum UA for predicting postoperative inhospital mortality. Results: Increased level of serum UA was found in non-survivors compared with those survived (446 ± 123 vs 371 ± 111 umol/L, p < 0.001). Age (OR = 1.063, 95% CI 1.016–1.112, p = 0.009), UA (OR = 1.006, 95% CI 1.002–1.010, p = 0.002), D-dimer (OR = 1.025, 95% CI 1.005–1.013, p = 0.012), operation time (OR = 1.009, 95% CI 1.005–1.013, p < 0.001) and extent of aortic replacement (OR = 0.412, 95% CI 0.220–0.768, p = 0.005) were identified as independent risk factors of in-hospital mortality in AAAD patients. The best cut-off value of admission serum UA in predicting in-hospital mortality was determined to be 415 umol/L. Subgroup analysis showed that in the subgroup of total arch replacement, UA was significantly associated with in-hospital death (OR = 1.010, 95% CI 1.005–1.015, p < 0.001), while in patients underwent ascending aorta replacement or hemiarch replacement, the relationship was no longer significant (OR = 1.001, 95% CI 0.996–1.006, p = 0.611). Conclusions: Elevated serum UA level on admission is an independent predictor of in-hospital mortality in patients with AAAD. Keywords: Uric acid, Acute type A aortic dissection, In-hospital mortality
Introduction Despite improvements in surgical technique, the early mortality after surgery for acute type A aortic dissection (AAAD) remained as high as high as 8–25% [1, 2]. Several laboratory indexes on admission such as D-dimer [3–5], C reactive protein (CRP) [3], fibrinogen [6], platelet count [7], and white blood cell count (WBC) [8] have been proven to be associated with early mortality in patients with aortic dissection. Uric acid (UA) is the final product of purines metabolism, which is converted from xanthine in an oxidation * Correspondence: [email protected] Department of Cardiovascular Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
reaction catalyzed by xanthine oxidoreductase [9]. Several experimental and human studies have shown the association between serum UA level and endothelial dysfunction [10], oxidative stress [11] and systemic inflammation [12]. Epidemiological studies suggested that increased serum UA level was associated with increased c
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