Blood Urea Nitrogen/Creatinine Ratio (BUR): A Novel Predictor of Early Prognosis in Acute Type A Aortic Dissection

Background: This study aims to evaluate the predictive value of the blood urea nitrogen/creatinine ratio (BUR) for the early prognosis of patients with acute type A aortic dissection (ATAAD) undergoing different surgical approaches. Methods: We examined clinical data from 250 patients diagnosed with ATAAD who underwent surgical treatment. Patients were divided into two groups based on the surgical approach: proximal repair and total arch replacement. The primary endpoints were in-hospital mortality, 30-day mortality, and acute kidney injury (AKI) analyzed in relation to BUR levels. Results: The receiver operating characteristic (ROC) curve for BUR demonstrated an area under the curve (AUC) of 0.72 for predicting in-hospital mortality, with an optimal cut-off value of 8.0. Patients with a BUR ≥8.0 were older, had a higher prevalence of hypertension and coronary artery disease, and exhibited a lower estimated glomerular filtration rate (eGFR) compared to those with a BUR <8.0. Multivariate analysis confirmed that a BUR ≥8.0 was an independent predictor of in-hospital mortality, 30-day mortality, and AKI. Kaplan-Meier survival analysis demonstrated that patients with a BUR ≥8.0 had significantly lower survival probabilities than those with a BUR <8.0, regardless of the surgical approach. The prognostic value of BUR was particularly pronounced in the total arch replacement group. Conclusions: The BUR is a novel and independent predictor of early prognosis in patients with ATAAD. It serves as a valuable tool for risk stratification and guide clinical decision-making, particularly in identifying high-risk patients prone to poor postoperative outcomes.