Predictive Value of the Uric Acid-to-Albumin Ratio for In-Hospital Mortality in Acute Pulmonary Embolism

Abstract

Pulmonary embolism (PE) remains a major cause of cardiovascular mortality, and early identification of high-risk patients is essential. The uric acid-to-albumin ratio (UAR) has emerged as a marker reflecting systemic inflammation. This study aimed to evaluate the prognostic value of UAR for in-hospital mortality in patients with acute PE. This single-center, retrospective study included 1052 consecutive patients diagnosed with acute PE. Clinical characteristics, laboratory parameters, echocardiographic findings, and pulmonary imaging results were obtained from hospital records. Multivariable logistic regression analyses were performed to identify independent predictors of in-hospital mortality. The discriminative performance of UAR was assessed using receiver operating characteristic (ROC) curve analysis. Overall, 70 patients (6.7%) died during hospitalization. Non-survivors had significantly higher UAR values compared with survivors (2.33 vs 1.57, P < .001). In multivariable analysis, UAR C-Reactive Protein, and Pulmonary artery severity index (PESI) score independently predicted in-hospital mortality. UAR demonstrated acceptable discriminative ability (Area under the curve .728; 95% CI: .649-.807; P < .001), with an optimal cut-off of 2.12. The combined use of UAR and PESI demonstrated a modest improvement in predictive performance. UAR is an independent predictor of in-hospital mortality in patients with acute PE. Its combination with the PESI score may provide incremental value for early risk stratification.