Preoperative serum alpha-hydroxybutyrate dehydrogenase level as a predictor of postoperative mortality and morbidity after noncardiac surgery: A propensity-adjusted analysis

Preoperative serum alpha-hydroxybutyrate dehydrogenase is reportedly associated with myocardial infarction. Myocardial injury after noncardiac surgery is independently associated with postoperative mortality. However, the association between preoperative alpha-hydroxybutyrate dehydrogenase and outcomes after noncardiac surgery has not been researched. We aimed to assess the association between preoperative serum alpha-hydroxybutyrate dehydrogenase levels and mortality and morbidity after noncardiac surgery.We conducted a retrospective cohort study on patients undergoing noncardiac surgery from 2018 to 2020 in Sichuan University West China Hospital. After multivariate adjustment, the alpha-hydroxybutyrate dehydrogenase level was verified to be associated with postoperative outcomes by logistic regression analyses and propensity score weighting methods.We obtained data from 130,880 patients. An elevated preoperative serum alpha-hydroxybutyrate dehydrogenase level was associated with increasing mortality (odds ratio 1.244, 1.190-1.300; P.001), myocardial injury after noncardiac surgery (odds ratio 1.198, 1.141-1.257; P.001), and intensive care unit admission (odds ratio 1.138, 1.111-1.166; P.001) in logistic regression analyses. The covariate balancing generalized propensity score methodology demonstrated similar results. After classifying alpha-hydroxybutyrate dehydrogenase as a binary variable with a cut-off value of 182, we found that mortality, myocardial injury after noncardiac surgery, and intensive care unit admission24 hours were significantly higher in the elevated alpha-hydroxybutyrate dehydrogenase group (5.458% vs 0.737%; odds ratio 1.771, 1.533-2.046; P.001), (3.598% vs 0.572%; odds ratio 1.636, 1.393-1.922; P.001), and (18.182% vs 6.442%; odds ratio 1.430, 1.327-1.542; P.001), respectively. Similarly, the inverse-probability-of-treatment weighted estimation demonstrated similar results.Our results suggest that the preoperative serum alpha-hydroxybutyrate dehydrogenase level was associated with in-hospital mortality, myocardial injury after noncardiac surgery, and intensive care unit admission after noncardiac surgery.