The Association Between Aspartate Transaminase to Alanine Transaminase Ratio and Perioperative Ischemic Stroke in Patients With Diabetes: A Retrospective Cohort Study

IF 4.8 1区医学 Q1 NEUROSCIENCES CNS Neuroscience & Therapeutics Pub Date : 2025-01-21 DOI:10.1111/cns.70223

Siyuan Liu, Binbin Wang, Libin Ma, Huikai Yang, Min Liu, Yuxiang Song, Zhikang Zhou, Jingsheng Lou, Daming Zhou, Jiangbei Cao, Yanhong Liu, Weidong Mi, Yulong Ma

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Abstract

Background

Patients with diabetes are at a high risk for perioperative ischemic stroke (PIS). The use of biomarkers to identify high-risk patients and predict PIS may provide considerable reference value in clinical decision-making. The aspartate transaminase/alanine transaminase ratio (De Ritis ratio) has been proven to be associated with specific diabetic complications. However, the association between the De Ritis ratio and PIS has not been evaluated in this population. This retrospective cohort study aimed to evaluate the association between the preoperative De Ritis ratio and PIS in patients with type 2 diabetes undergoing noncardiovascular surgery.

Methods

Data from surgical patients were collected from January 2008 to August 2019. A total of 27,643 patients with type 2 diabetes mellitus (DM) undergoing noncardiovascular surgery under general anesthesia were screened. The optimal De Ritis ratio cutoff value was identified using the receiver operating characteristic (ROC) curve. Logistic regression models were used to evaluate the association between the preoperative De Ritis ratio and PIS. Propensity score matching (PSM), sensitivity analyses, and subgroup analyses were performed to further validate the robustness of this association.

Results

A total of 151 patients experienced PIS. A De Ritis ratio ≥ 1.04 was associated with an elevated risk of PIS after adjusting for baseline characteristics (OR [95% CI]: 2.25 [1.59–3.21]; p < 0.001), intraoperative parameters (2.50 [1.80–3.49]; p < 0.001), and all confounding variables (2.29 [1.61–3.29]; p < 0.001). In the propensity score-matched cohort, the association between the De Ritis ratio and PIS remained significant (2.04 [1.38–3.05]; p < 0.001). These associations were also consistently maintained in the sensitivity and subgroup analyses.

Conclusions

An elevated De Ritis ratio is strongly associated with a higher risk of PIS in patients with type 2 DM undergoing noncardiovascular surgery. This may provide additional information on PIS risk assessment in patients with type 2 DM undergoing noncardiovascular surgery.

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谷草转氨酶与丙氨酸转氨酶比值与糖尿病患者围手术期缺血性卒中的相关性：一项回顾性队列研究。

背景：糖尿病患者是围手术期缺血性卒中（PIS）的高危人群。利用生物标志物识别高危患者并预测PIS可能对临床决策提供相当大的参考价值。天冬氨酸转氨酶/丙氨酸转氨酶比值（De Ritis ratio）已被证实与特定的糖尿病并发症有关。然而，在这一人群中，De - Ritis比率与PIS之间的关系尚未得到评估。本回顾性队列研究旨在评估接受非心血管手术的2型糖尿病患者术前De - Ritis比率与PIS之间的关系。方法：收集2008年1月至2019年8月手术患者的数据。在全麻下接受非心血管手术的2型糖尿病（DM）患者共27,643例。采用受试者工作特征（ROC）曲线确定最佳德里斯比临界值。采用Logistic回归模型评估术前De - Ritis ratio与PIS之间的关系。进行倾向评分匹配（PSM）、敏感性分析和亚组分析以进一步验证这种关联的稳健性。结果：151例患者出现PIS。在调整基线特征后，De - Ritis ratio≥1.04与PIS风险升高相关(OR [95% CI]: 2.25 [1.59-3.21]；结论：在接受非心血管手术的2型糖尿病患者中，德炎比率升高与PIS的高风险密切相关。这可能为接受非心血管手术的2型糖尿病患者的PIS风险评估提供额外的信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.