Background Postoperative hepatic dysfunction is a frequent and severe complication in patients with acute type A aortic dissection (ATAAD) following emergency surgical repair, and it is strongly associated with adverse clinical outcomes and poor prognosis. The albumin-bilirubin (ALBI) score is an objective and well-validated indicator for evaluating hepatic function and reserve. Accumulating evidence has demonstrated its favorable prognostic value across a variety of clinical conditions, including cardiovascular diseases. Accordingly, this study was performed to comprehensively investigate the prognostic significance of the ALBI score in patients with ATAAD undergoing emergency surgical repair. Method A total of 306 patients with ATAAD who underwent emergent repair surgery were enrolled in this single-center retrospective study. The primary outcomes of interest included delayed extubation, reintubation, neurological dysfunction, requirement for continuous renal replacement therapy (CRRT), and 30-day mortality. Propensity score matching (PSM) was performed to balance baseline characteristics between low and high postoperative ALBI (postALBI) score groups, followed by comparison of adverse outcome incidences. Multivariate logistic regression analysis was used to identify independent risk factors for poor prognosis. Results After PSM, 191 matched pairs were obtained. The high postALBI group (≥-2.12) exhibited significantly higher rates of delayed extubation (40.34% vs. 18.48%, P < 0.001), CRRT requirement (31.93% vs. 10.92%, P < 0.01), and 30-day mortality (16.81% vs. 6.72%, P = 0.017) compared to the low postALBI group (<-2.12). Although the reintubation rate was higher in the high postALBI group (18.52% vs. 9.24%), the difference approached but did not reach statistical significance (P = 0.064). Multivariate analysis revealed that high postALBI was consistently identified as a common risk factor for all adverse outcomes, including delayed extubation (OR: 2.670; 95%CI: 1.080–6.601, P = 0.033), reintubation (OR: 3.071; 95%CI: 1.076–8.769, P = 0.036), neurological dysfunction (OR: 4.174; 95%CI: 1.354–12.868, P = 0.013), CRRT requirement (OR: 4.25; 95%CI: 1.544–11.699, P = 0.005), and 30-day mortality (OR: 3.215; 95%CI: 1.132–9.127, P = 0.028). The postALBI score exhibited superior discriminatory ability over individual liver function parameters (postoperative albumin and total bilirubin) for predicting multiple adverse clinical outcomes: its AUC and 95% CI were 0.668 (0.547–0.788, P = 0.006) for 30-day mortality, 0.737 (0.645–0.829, P < 0.001) for CRRT requirement, 0.730 (0.582–0.879, P = 0.002) for neurological dysfunction, 0.706 (0.588–0.824, P = 0.001) for reintubation, and 0.637 (0.548–0.725, P = 0.003) for delayed extubation. Conclusions The postALBI score demonstrates independent prognostic potential for postoperative adverse events in patients with ATAAD undergoing emergent surgical repair. Owing to its simplicity and wide accessibility, this score may serve as a supportive tool for postoperative risk stratification and clinical decision-making in this high-risk population.

Prognostic value of postoperative albumin-bilirubin score in patients with acute type A aortic dissection after surgery: a propensity-score matched analysis

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2026年6月22日

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Jia-Wen Hu,
Tao Shi

摘要

Background

Postoperative hepatic dysfunction is a frequent and severe complication in patients with acute type A aortic dissection (ATAAD) following emergency surgical repair, and it is strongly associated with adverse clinical outcomes and poor prognosis. The albumin-bilirubin (ALBI) score is an objective and well-validated indicator for evaluating hepatic function and reserve. Accumulating evidence has demonstrated its favorable prognostic value across a variety of clinical conditions, including cardiovascular diseases. Accordingly, this study was performed to comprehensively investigate the prognostic significance of the ALBI score in patients with ATAAD undergoing emergency surgical repair.

Method

A total of 306 patients with ATAAD who underwent emergent repair surgery were enrolled in this single-center retrospective study. The primary outcomes of interest included delayed extubation, reintubation, neurological dysfunction, requirement for continuous renal replacement therapy (CRRT), and 30-day mortality. Propensity score matching (PSM) was performed to balance baseline characteristics between low and high postoperative ALBI (postALBI) score groups, followed by comparison of adverse outcome incidences. Multivariate logistic regression analysis was used to identify independent risk factors for poor prognosis.

Results

After PSM, 191 matched pairs were obtained. The high postALBI group (≥-2.12) exhibited significantly higher rates of delayed extubation (40.34% vs. 18.48%, P < 0.001), CRRT requirement (31.93% vs. 10.92%, P < 0.01), and 30-day mortality (16.81% vs. 6.72%, P = 0.017) compared to the low postALBI group (<-2.12). Although the reintubation rate was higher in the high postALBI group (18.52% vs. 9.24%), the difference approached but did not reach statistical significance (P = 0.064). Multivariate analysis revealed that high postALBI was consistently identified as a common risk factor for all adverse outcomes, including delayed extubation (OR: 2.670; 95%CI: 1.080–6.601, P = 0.033), reintubation (OR: 3.071; 95%CI: 1.076–8.769, P = 0.036), neurological dysfunction (OR: 4.174; 95%CI: 1.354–12.868, P = 0.013), CRRT requirement (OR: 4.25; 95%CI: 1.544–11.699, P = 0.005), and 30-day mortality (OR: 3.215; 95%CI: 1.132–9.127, P = 0.028). The postALBI score exhibited superior discriminatory ability over individual liver function parameters (postoperative albumin and total bilirubin) for predicting multiple adverse clinical outcomes: its AUC and 95% CI were 0.668 (0.547–0.788, P = 0.006) for 30-day mortality, 0.737 (0.645–0.829, P < 0.001) for CRRT requirement, 0.730 (0.582–0.879, P = 0.002) for neurological dysfunction, 0.706 (0.588–0.824, P = 0.001) for reintubation, and 0.637 (0.548–0.725, P = 0.003) for delayed extubation.

Conclusions

The postALBI score demonstrates independent prognostic potential for postoperative adverse events in patients with ATAAD undergoing emergent surgical repair. Owing to its simplicity and wide accessibility, this score may serve as a supportive tool for postoperative risk stratification and clinical decision-making in this high-risk population.