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Background: A study was designed to determine significant variables that could be used to predict survival in patients with ruptured abdominal aortic aneurysm., Patients and Methods: Data of 106 unselected consecutive patients with ruptured abdominal aortic aneurysm undergoing operation between 1989 and 1998 were identified from a prospective hospital-based registry. A total of 32 variables were analyzed including demographic characteristics, vascular risk factors, coexisting conditions, preoperative findings, intraoperative variables, and postoperative complications. Preoperative and intraoperative variables related to vital status (alive, death) in the univariate analysis were subjected to stepwise linear regression analysis to determine whether a combination of variables would predict death. Of 99 evaluable patients, 48 died (mortality rate 48.5%)., Results: At univariate analysis, age, serum creatinine, hemoglobin, electrocardiographic ischemia, loss of consciousness on admission, preoperative shock, supra-renal rupture, and transfusion requirements were significantly associated with 30-day operative mortality. Postoperative complications except sepsis, mesenteric ischemia, and neurologic events were significantly associated with mortality. Electrocardiographic ischemia, shock, and supra-renal rupture appeared to be independent predictors of mortality in the multivariate analysis. The cumulative effect of 0, 1, and > or = 2 risk factors on mortality was 29%, 39%, and 90%, respectively., Conclusions: Electrocardiographic ischemia, preoperative shock, and supra-renal rupture were predictors of death in patients with ruptured abdominal aortic aneurysm.