血清白蛋白/肌酐比值预测急性主动脉夹层住院死亡率的价值及血肌酐与死亡风险的非线性关系OA

Objective To investigate the prognostic value of the serum albumin-to-creatinine ratio(sACR)for in-hospital mortality in patients with acute aortic dissection(AAD)and to explore the nonlinear association between serum creatinine(sCr)and mortality risk.Methods A total of 990 patients diagnosed with AAD were retrospectively enrolled.Cox proportional hazards regression,restricted cubic spline(RCS)analysis,and propensity score matching(PSM)were applied to evaluate the associations between sACR,sCr,and in-hospital mortality.The predictive perform-ance of sACR was assessed using the area under the receiver operating characteristic curve(AUC)and integrated discrim-ination improvement(IDI).Results Patients who died during hospitalization had significantly lower sACR levels than survivors(2.3 vs.3.6,P＜0.001).Multivariable Cox regression identified sACR as an independent protective factor for in-hospital mortality(HR=0.70;95％CI:0.55-0.90,P=0.006).RCS analysis demonstrated a U-shaped rela-tionship between sCr and mortality risk,with increased risk observed at sCr levels＜0.6 mg/dL(HR=3.75)and＞1.1 mg/dL(HR=2.30).Subgroup analyses revealed that sACR was a significant predictor of mortality in patients with type A AAD managed non-surgically(HR=0.62)and in surgically treated type B AAD patients(HR=0.07).The AUC of sACR for predicting in-hospital mortality was 0.697,which was significantly higher than that of serum albumin alone(0.638)or sCr alone(0.675)(P＜0.05).Conclusion The serum albumin-to-creatinine ratio is an independent predictor of in-hospital mortality in patients with acute aortic dissection.Its prognostic value varies across clinical sub-groups and may facilitate early risk stratification and clinical decision-making.