De Ritis Ratio as an Independent Predictor of In-Hospital Mortality in Surgically Treated Acute Aortic Dissection

Background/Objectives: Every hour of delay in treating acute aortic dissection (AAD) increases mortality by 1-2%, underscoring the critical need for rapid identification of high-risk patients. Despite advances in surgical management, in-hospital mortality remains substantial, and early, reliable risk stratification tools are urgently needed. We targeted to assess the relationship between the De Ritis ratio (DRr) and in-hospital mortality in patients experiencing surgery for AAD. Methods: In this single-center retrospective study, 182 patients who underwent surgery for AAD between 2020 and 2025 were included. Demographic, clinical, laboratory, and echocardiographic data were analyzed. Receiver operating characteristic analysis was used to estimate the DRr's discriminatory ability, and univariable and multivariable logistic regression analyses were utilized to find predictors of in-hospital mortality. Results: In-hospital mortality occurred in 59 patients (32.4%). When comparing survivors to non-survivors, the DRr was noticeably greater. Along with age, lactate level, and ejection fraction, the DRr continued to be an independent predictor of in-hospital mortality in multivariable analysis. Receiver operating characteristic analysis showed moderate discriminatory performance of the DRr, with an area under the curve of 0.701 and an optimal cut-off value of 1.308. Conclusions: The DRr is a practical and accessible biomarker related to in-hospital mortality in surgically treated AAD and may provide incremental prognostic value when used alongside established clinical and laboratory parameters.