Association of serum albumin to creatinine ratio with mortality in patients with aortic disease: a cohort study.

Abstract

Most previous studies have only examined the relationship between albumin or creatinine alone and the prognosis of patients with aortic disease (AD). Therefore, the aim of this study was to evaluate the association between serum albumin to creatinine ratio (sACR) and all-cause mortality (ACM) in patients with AD. This retrospective cohort study utilized the Medical Information Mart for Intensive Care IV, stratifying sACR into tertiles. The primary outcome (28-day ACM) and the secondary outcomes in critically ill AD patients were analyzed via restricted cubic splines and multivariate Cox proportional hazards models. Survival differences across sACR tertiles were assessed by Kaplan-Meier analysis, supplemented by subgroup interactions and receiver operating characteristic (ROC) curve evaluation of sACR's prognostic accuracy. This study included 499 AD patients (67.3% male). Multivariate Cox proportional hazards models with log₁₀-transformed sACR revealed each tenfold sACR increase reduced mortality risk by 78% at 28 days (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.12-0.40), 78% at 90 days (HR 0.22, 95% CI 0.13-0.37), and 74% at 1 year (HR 0.26, 0.17-0.42; all P < 0.001). Restricted cubic splines confirmed linear dose-response relationships (P for non-linear > 0.05). Kaplan-Meier curves demonstrated significantly lower mortality in high sACR tertiles, consistent across subgroups. ROC analysis validated prognostic accuracy. sACR was negatively associated with both short- and long-term mortality in patients with AD. These findings advance prognostic biomarker research by confirming sACR's clinical utility in AD.