Impact of preoperative hyperuricemia on the prognosis of patients with acute type A aortic dissection.

Background: The mortality of patients with acute type A aortic dissection remains high, and it is imperative to explore the risk factors that affect patient prognosis. Methods and results: 485 patients with acute type A aortic dissection who underwent surgery were included in our study. Based on preoperative serum uric acid tests, the patients were divided into two groups. After adjusting baseline data (SMD < 0.1), the 30-day mortality (19.4 % vs 6.2 %, P < 0.001) in the hyperuricemia group were significantly higher. Univariate and multivariate COX regression revealed that hyperuricemia was an independent risk factor for 30-day mortality in patients (HR, 2.2; P = 0.016). In subgroup analysis, the trend of increased mortality in the hyperuricemia group was consistent. In a median follow-up time of 6.2 years, Landmark analysis showed that the mortality of the hyperuricemia group mainly increased significantly within 1 month after surgery (Log-rank P < 0.001), and there was no significant difference after 1 month (Log-rank P = 0.506). Through restricted cubic spline, it was found that the risk of death gradually increases with preoperative blood uric acid levels above 330 μmol/L. Conclusion: Preoperative hyperuricemia was an independent risk factor for early mortality in patients with acute type A aortic dissection, but it did not affect the mid-term survival in patients who survived the early postoperative period.