Association between fasting blood glucose-to-albumin ratio and short-term outcomes after abdominal aortic aneurysm repair_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAO Jiashu ¹ , ZHANG Yepeng ² , WANG Jie ² , WU Guangyan ² , CHEN Wenqing ¹ , LI Xiangrui ¹ , GAO Bo ¹ ,  CHEN Xiaotian ¹ ,  ZHOU Min ²

1. Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210009, P. R. China;
2. Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210009, P. R. China;

Corresponding author：

CHEN Xiaotian, Email: xttchen@163.com; ZHOU Min, Email: zhouminnju@126.com

Keywords：

fasting blood glucose; albumin; abdominal aortic aneurysm; mortality; complications

DOI：

10.7507/1007-9424.202504129

Video：

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Objective To investigate the association between the admission fasting blood glucose-to-albumin ratio (FAR) and short-term prognosis in patients with abdominal aortic aneurysm (AAA) underwent open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Methods A retrospective study was conducted on patients with AAA who underwent OSR or EVAR at Nanjing Drum Tower Hospital from January 2020 to January 2024 and met the inclusion criteria. The receiver operating characteristic (ROC) curve was used to evaluate the discriminative ability of the FAR for in-hospital mortality after AAA surgery and to determine its optimal cutoff value. Patients were then divided into a low-FAR group (FAR below the cutoff) and a high-FAR group (FAR equal to or above the cutoff) based on this value. Logistic regression analysis, Cox proportional hazards regression models, and Kaplan-Meier survival curves were employed to examine the relation between FAR and postoperative severe complications (Clavien-Dindo grade Ⅲ or above) as well as in-hospital all-cause mortality. Results A total of 191 patients were included in this study. The area under the ROC curve of FAR for predicting in-hospital mortality was 0.707 [95%CI (0.637, 0.770)], with an optimal cutoff value of 2.33. There were 164 patients in the low-FAR group and 27 in the high-FAR group. The incidence of postoperative severe complications and in-hospital all-cause mortality were significantly higher in the high-FAR group compared to the low-FAR group [22.22% (6/27) vs. 12.20% (20/164), χ²=5.22, P=0.029; 14.81% (4/27) vs. 2.44% (4/164), χ²=6.03, P=0.014]. An elevated FAR was identified as a risk factor for both postoperative severe complications [OR (95%CI)=1.49 (1.27, 1.88), P=0.018] and in-hospital all-cause mortality [OR (95%CI)=1.35 (1.29, 3.06, P=0.047]. Kaplan-Meier survival analysis showed significantly worse survival in patients with a high-FAR compared to those with a low-FAR (χ²=10.44, P=0.001). Conclusion Elevated AAR is a risk factor for poor in-hospital prognosis in AAA patients treated with OSR or EVAR and may serve as a valuable marker for assessing short-term outcomes.

1.	Anagnostakos J, Lal BK. Abdominal aortic aneurysms. Prog Cardiovasc Dis, 2021, 5: 34-43.
2.	Kumar M, Long GW, Major M, et al. Predictors of mortality in nonagenarians undergoing abdominal aortic aneurysm repair: analysis of the National Surgical Quality Improvement Program dataset. J Vasc Surg, 2022, 75(4): 1223-1233.
3.	Tan X, Jung G, Herrmann E, et al. Sex difference in early mortality after abdominal aortic aneurysm repair. J Vasc Surg, 2023, 77(6): 1658-1668.
4.	Visser JJ, Williams M, Kievit J, et al. Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms. J Vasc Surg, 2009, 49(5): 1093-1099.
5.	Hemingway JF, Caps M, Zettervall SL, et al. Modified Harborview Risk Score improves ease in predicting mortality after ruptured abdominal aortic aneurysm repair. J Vasc Surg, 2024, 79(3): 562-568.
6.	von Meijenfeldt GC, van Beek SC, Bastos Gonçalves F, et al. Development and external validation of a model predicting death after surgery in patients with a ruptured abdominal aortic aneurysm: The Dutch Aneurysm Score. Eur J Vasc Endovasc Surg, 2017, 53(2): 168-174.
7.	Raffort J, Lareyre F, Clément M, et al. Diabetes and aortic aneurysm: current state of the art. Cardiovasc Res, 2018, 114(13): 1702-1713.
8.	Koole D, van Herwaarden JA, Schalkwijk CG, et al. A potential role for glycated cross-links in abdominal aortic aneurysm disease. J Vasc Surg, 2017, 65(5): 1493-1503.
9.	Li Y, Zheng X, Guo J, et al. Treatment with small molecule inhibitors of advanced glycation end-products formation and advanced glycation end-products-mediated collagen cross-linking promotes experimental aortic aneurysm progression in diabetic mice. J Am Heart Assoc, 2023, 12(10): e028081. doi: 10.1161/JAHA.122.028081.
10.	Long CA, Fang ZB, Hu FY, et al. Poor glycemic control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgery. J Vasc Surg, 2019, 69(4): 1219-1226.
11.	Sigurdardottir M, Sigurdsson MI, Olafsson Y, et al. Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections. Acta Orthop, 2023, 94: 38-44.
12.	Inagaki E, Farber A, Eslami MH, et al. Preoperative hypoalbuminemia is associated with poor clinical outcomes after open and endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2017, 66(1): 53-63.
13.	Zhen C, Chen W, Chen W, et al. Association between admission-blood-glucose-to-albumin ratio and clinical outcomes in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. Front Cardiovasc Med, 2023, 10: 1132685. doi: 10.3389/fcvm.2023.1132685.
14.	Wohlauer M, Brier C, Kuramochi Y, et al. Preoperative hypoalbuminemia is a risk factor for early and late mortality in patients undergoing endovascular juxtarenal and thoracoabdominal aortic aneurysm repair. Ann Vasc Surg, 2017, 42: 198-204.
15.	Isselbacher EM, Preventza O, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines. J Thorac Cardiovasc Surg, 2023, 166(5): e182-e331.
16.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
17.	Zhang S, Liu J, Jia X, et al. Investigating the inverse association between glycaemia and abdominal aortic dilatation in a large Chinese hypertensive population: a cross-sectional study. Ann Transl Med, 2022, 10(7): 419. doi: 10.21037/atm-22-1256.
18.	Zhang F, Kent KC, Yamanouchi D, et al. Anti-receptor for advanced glycation end products therapies as novel treatment for abdominal aortic aneurysm. Ann Surg, 2009, 250(3): 416-423.
19.	Hofmann Bowman M, Wilk J, Heydemann A, et al. S100A12 mediates aortic wall remodeling and aortic aneurysm. Circ Res, 2010, 106(1): 145-154.
20.	Bláha J, Mráz M, Kopecký P, et al. Perioperative tight glucose control reduces postoperative adverse events in nondiabetic cardiac surgery patients. J Clin Endocrinol Metab, 2015, 100(8): 3081-3089.
21.	Roberts GW, Quinn SJ, Valentine N, et al. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab, 2015, 100(12): 4490-4497.
22.	Xu W, Yang YM, Zhu J, et al. Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study. Cardiovasc Diabetol, 2022, 21(1): 48. doi: 10.1186/s12933-022-01479-8.
23.	Kaiafa G, Veneti S, Polychronopoulos G, et al. Is HbA1c an ideal biomarker of well-controlled diabetes?. Postgrad Med J, 2021, 97(1148): 380-383.
24.	Fanali G, di Masi A, Trezza V, et al. Human serum albumin: from bench to bedside. Mol Aspects Med, 2012, 33(3): 209-290.
25.	Rozga J, Piątek T, Małkowski P. Human albumin: old, new, and emerging applications. Ann Transplant, 2013, 18: 205-217.
26.	Yoon HJ, Kim TH, Ko DE, et al. Postoperative hypoalbuminemia as a predictor of acute kidney injury after open repair of ruptured abdominal aortic aneurysm. World J Surg, 2023, 47(12): 3382-3393.

1. Anagnostakos J, Lal BK. Abdominal aortic aneurysms. Prog Cardiovasc Dis, 2021, 5: 34-43.
2. Kumar M, Long GW, Major M, et al. Predictors of mortality in nonagenarians undergoing abdominal aortic aneurysm repair: analysis of the National Surgical Quality Improvement Program dataset. J Vasc Surg, 2022, 75(4): 1223-1233.
3. Tan X, Jung G, Herrmann E, et al. Sex difference in early mortality after abdominal aortic aneurysm repair. J Vasc Surg, 2023, 77(6): 1658-1668.
4. Visser JJ, Williams M, Kievit J, et al. Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms. J Vasc Surg, 2009, 49(5): 1093-1099.
5. Hemingway JF, Caps M, Zettervall SL, et al. Modified Harborview Risk Score improves ease in predicting mortality after ruptured abdominal aortic aneurysm repair. J Vasc Surg, 2024, 79(3): 562-568.
6. von Meijenfeldt GC, van Beek SC, Bastos Gonçalves F, et al. Development and external validation of a model predicting death after surgery in patients with a ruptured abdominal aortic aneurysm: The Dutch Aneurysm Score. Eur J Vasc Endovasc Surg, 2017, 53(2): 168-174.
7. Raffort J, Lareyre F, Clément M, et al. Diabetes and aortic aneurysm: current state of the art. Cardiovasc Res, 2018, 114(13): 1702-1713.
8. Koole D, van Herwaarden JA, Schalkwijk CG, et al. A potential role for glycated cross-links in abdominal aortic aneurysm disease. J Vasc Surg, 2017, 65(5): 1493-1503.
9. Li Y, Zheng X, Guo J, et al. Treatment with small molecule inhibitors of advanced glycation end-products formation and advanced glycation end-products-mediated collagen cross-linking promotes experimental aortic aneurysm progression in diabetic mice. J Am Heart Assoc, 2023, 12(10): e028081. doi: 10.1161/JAHA.122.028081.
10. Long CA, Fang ZB, Hu FY, et al. Poor glycemic control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgery. J Vasc Surg, 2019, 69(4): 1219-1226.
11. Sigurdardottir M, Sigurdsson MI, Olafsson Y, et al. Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections. Acta Orthop, 2023, 94: 38-44.
12. Inagaki E, Farber A, Eslami MH, et al. Preoperative hypoalbuminemia is associated with poor clinical outcomes after open and endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2017, 66(1): 53-63.
13. Zhen C, Chen W, Chen W, et al. Association between admission-blood-glucose-to-albumin ratio and clinical outcomes in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. Front Cardiovasc Med, 2023, 10: 1132685. doi: 10.3389/fcvm.2023.1132685.
14. Wohlauer M, Brier C, Kuramochi Y, et al. Preoperative hypoalbuminemia is a risk factor for early and late mortality in patients undergoing endovascular juxtarenal and thoracoabdominal aortic aneurysm repair. Ann Vasc Surg, 2017, 42: 198-204.
15. Isselbacher EM, Preventza O, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines. J Thorac Cardiovasc Surg, 2023, 166(5): e182-e331.
16. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
17. Zhang S, Liu J, Jia X, et al. Investigating the inverse association between glycaemia and abdominal aortic dilatation in a large Chinese hypertensive population: a cross-sectional study. Ann Transl Med, 2022, 10(7): 419. doi: 10.21037/atm-22-1256.
18. Zhang F, Kent KC, Yamanouchi D, et al. Anti-receptor for advanced glycation end products therapies as novel treatment for abdominal aortic aneurysm. Ann Surg, 2009, 250(3): 416-423.
19. Hofmann Bowman M, Wilk J, Heydemann A, et al. S100A12 mediates aortic wall remodeling and aortic aneurysm. Circ Res, 2010, 106(1): 145-154.
20. Bláha J, Mráz M, Kopecký P, et al. Perioperative tight glucose control reduces postoperative adverse events in nondiabetic cardiac surgery patients. J Clin Endocrinol Metab, 2015, 100(8): 3081-3089.
21. Roberts GW, Quinn SJ, Valentine N, et al. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab, 2015, 100(12): 4490-4497.
22. Xu W, Yang YM, Zhu J, et al. Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study. Cardiovasc Diabetol, 2022, 21(1): 48. doi: 10.1186/s12933-022-01479-8.
23. Kaiafa G, Veneti S, Polychronopoulos G, et al. Is HbA1c an ideal biomarker of well-controlled diabetes?. Postgrad Med J, 2021, 97(1148): 380-383.
24. Fanali G, di Masi A, Trezza V, et al. Human serum albumin: from bench to bedside. Mol Aspects Med, 2012, 33(3): 209-290.
25. Rozga J, Piątek T, Małkowski P. Human albumin: old, new, and emerging applications. Ann Transplant, 2013, 18: 205-217.
26. Yoon HJ, Kim TH, Ko DE, et al. Postoperative hypoalbuminemia as a predictor of acute kidney injury after open repair of ruptured abdominal aortic aneurysm. World J Surg, 2023, 47(12): 3382-3393.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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