Predictive value of the serum albumin-to-creatinine ratio for in-hospital mortality in acute aortic dissection and the nonlinear association between serum creatinine and mortality risk
CHEN Jia-de
HU Chuang-jia
CHEN Ye-qun
DENG Xiu-lian
Abstract：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.
Keywords：acute aortic dissectionserum albumin-to-creatinine ratioin-hospital mortalityU-shaped re-lationshipprognostic assessment
Publication Date：2026-01-15
Online Publishing Date：2026-03-04(First online date of this platform, not the publication date of the document)
Pages：9( 55-63 )