Risk factors for perioperative mortality in acute aortic dissection and the construction of a Nomogram prediction model_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DENG Tie ^1,2 , LI Bangguo ¹ ,  YU Hong ¹

1. Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, 563003, Guizhou, P. R. China;
2. Medical Imaging Department, Chongqing University Central Hospital, Chongqing, 400010, P. R. China;

Corresponding?author：

YU Hong, Email: yuhongv@163.com

Keywords：

Acute aortic dissection; computed tomography angiography; perioperative mortality; risk factors; Nomogram; Stanford type A aortic dissection; logistic regression; risk prediction

DOI：

10.7507/1007-4848.202403006

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Objective To investigate the value of preoperative clinical data and computed tomography angiography (CTA) data in predicting perioperative mortality risk in patients with acute aortic dissection (AAD), and to construct a Nomogram prediction model. Methods A retrospective study was conducted on AAD patients treated at Affiliated Hospital of Zunyi Medical University from February 2013 to July 2023. Patients who died during the perioperative period were included in the death group, and those who improved during the same period were randomly selected as the non-death group using a random number table method. The first CTA data and preoperative clinical data within the perioperative period of the two groups were collected, and related risk factors were analyzed to screen out independent predictive factors for perioperative death. The Nomogram prediction model for perioperative mortality risk in AAD patients was constructed using the screened independent predictive factors, and the effect of the Nomogram was evaluated by calibration curves and area under the curve (AUC). Results A total of 270 AAD patients were included. There were 60 patients in the death group, including 42 males and 18 females with an average age of (56.89±13.42) years. There were 210 patients in the non-death group, including 163 males and 47 females with an average age of (56.15±13.77) years. Multivariate logistic regression analysis showed that type A AAD [OR=4.589, 95%CI (2.273, 9.267), P<0.001], irregular tear morphology [OR=2.054, 95%CI (1.025, 4.117), P=0.042], decreased hemoglobin [OR=0.983, 95%CI (0.971, 0.995), P=0.007], increased uric acid [OR=1.003, 95%CI (1.001, 1.005), P=0.004], and increased aspartate aminotransferase [OR=1.003, 95%CI (1.000, 1.006), P=0.035] were independent risk factors for perioperative death in AAD patients. The Nomogram prediction model constructed using the above risk factors had an AUC of 0.790 for predicting perioperative death, indicating good predictive performance. Conclusion Type A AAD, irregular tear morphology, decreased hemoglobin, increased uric acid, and increased aspartate aminotransferase are independent predictive factors for perioperative death in AAD patients. The Nomogram prediction model constructed using these factors can help assess the perioperative mortality risk of AAD patients.

Citation： DENG Tie, LI Bangguo, YU Hong. Risk factors for perioperative mortality in acute aortic dissection and the construction of a Nomogram prediction model. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(3): 424-430. doi: 10.7507/1007-4848.202403006 Copy

1.	中國醫師協會心血管外科分會大血管外科專業委員會. 主動脈夾層診斷與治療規范中國專家共識. 中華胸心血管外科雜志, 2017, 33(11): 641-654.The Committee of Great Vessels of Chinese Assonciation of Cardiovascular Surgeons. Chinese experts' consensus of standardized diagnosis and treatment for aortic dissection. Chin J Thorac Cardiovasc Surg, 2017, 33(11): 641–654.
2.	Tadros RO, Tang GHL, Barnes HJ, et al. Optimal treatment of uncomplicated type B aortic dissection: JACC Review Topic of the Week. J Am Coll Cardiol, 2019, 74(11): 1494-1504.
3.	韓輝, 羅明堯, 舒暢. 2022年美國胸外科醫師學會/胸外科協會《B型主動脈夾層臨床診療指南》解讀. 中國胸心血管外科臨床雜志, 2022, 29(7): 820-827.Han H, Luo MY, Shu C. Interpretation of clinical practice guidelines for type B aortic dissection of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery in 2022. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(7): 820-827.
4.	李鑫, 李全明, 王倫常, 等. 主動脈夾層生物標志物的應用、探索與展望. 中華普通外科雜志, 2021, 36(4): 318-320.Li X, Li QM, Wang LC, et al. Application, exploration and prospect of biomarkers in aortic dissection. Chin J Gen Surg, 2021, 36(4): 318-320.
5.	馬倩倩, 王淑紅, 丁琦, 等. 急性主動脈夾層患者院內死亡的危險因素分析. 心肺血管病雜志, 2021, 40(5): 468-472.Ma QQ, Wang SH, Ding Q, et al. Risk factors for in-hospital mortality in patients with acute aortic dissection. J Cardiovasc Pulm Dis, 2021, 40(5): 468-472.
6.	張煥耀, 吳浩龍. 急性主動脈夾層患者院內死亡的危險因素分析. 內科, 2018, 13(4): 672-674.Zhang HY, Wu HL. Analysis of risk factors for in-hospital mortality in patients with acute aortic dissection. Intern Med, 2018, 13(4): 672-674.
7.	李末寒, 陳一歡, 吳云, 等. 急性主動脈夾層患者住院期間死亡的預警評分. 中國急救醫學, 2020, 40(11): 1065-1071.Li MH, Chen YH, Wu Y, et al. Early warning score for in-hospital mortality in the patients with acute aortic dissection. Chin J Crit Care Med, 2020, 40(11): 1065-1071.
8.	張煒宗, 馬翔, 袁紅, 等. 主動脈夾層患者院內死亡的Bayes判別分析研究. 中國全科醫學, 2019, 22(21): 2571-2576.Zhang WZ, Ma X, Yuan H, et al. Bayes discriminant analysis for in-hospital death of aortic dissection. Chin Gen Pract, 2019, 22(21): 2571-2576.
9.	陳璟, 何軍. 主動脈夾層患者院內死亡危險因素18年回顧性分析. 中國全科醫學, 2020, 23(32): 4091-4095.Chen J, He J. Risk factors for in-hospital mortality in aortic dissection: a 18-year retrospective study. Chin Gen Pract, 2020, 23(32): 4091-4095.
10.	Wang M, Luo L, Xia X, et al. A simple model predicting in-hospital death in patients with type A acute aortic dissection. Perfusion, 2022, 37(8): 847-851.
11.	Chi Q, He Y, Luan Y, et al. Numerical analysis of wall shear stress in ascending aorta before tearing in type A aortic dissection. Comput Biol Med, 2017, 89: 236-247.
12.	寧世鋒, 易東, 鄢華. 急性Stanford A型主動脈夾層累及冠狀動脈診療進展. 中國循證心血管醫學雜志, 2022, 14(1): 124-126.Ning SF, Yi D, Yan H. Progress in diagnosis and treatment of acute Stanford type A aortic dissection involving coronary arteries. Chin J Evid Based Cardiovasc Med, 2022, 14(1): 124-126.
13.	薛昱, 韓青松, 鞏勇智, 等. 主動脈夾層近心端不同破口形態下的血流動力學分析. 醫用生物力學, 2021, 36(5): 751-756.Xue Y, Han QS, Gong YZ, et al. Hemodynamic analysis on proximal end of the aortic dissection with different rupture shapes. J Med Biomech, 2021, 36(5): 751-756.
14.	李艷麗, 高晴云, 馮俊波, 等. Stanford A型主動脈夾層手術死亡風險因素分析. 中華全科醫學, 2022, 20(1): 18-21, 103.Li YL, Gao QY, Feng JB, et al. The death risk factors of Stanford A aortic dissection surger. Chin J Gen Pract, 2022, 20(1): 18-21, 103.
15.	Kimura S, Sato H, Shimajiri S, et al. An acute aortic dissection prognostic score for predicting early in-hospital mortality in acute thoracic aortic dissection. Am Heart J Plus, 2025, 52: 100521.
16.	Luo YX, Matniyaz Y, Tang YX, et al. Postoperative hyper-inflammation as a predictor of poor outcomes in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair. J Cardiothorac Surg, 2024, 19(1):138.
17.	Zhang Y, Xu X, Lu Y, et al. Preoperative uric acid predicts in-hospital death in patients with acute type A aortic dissection. J Cardiothorac Surg, 2020, 15(1): 21.
18.	孫芳, 宋曉春, 陳永銘, 等. 急性Stanford A型主動脈夾層術后早期死亡因素分析. 中國心血管雜志, 2020, 25(2): 156-159.Sun F, Song XC, Chen YM, et al. Analysis of risk factors of early postoperative death in patients with acute Stanford type A aortic dissection. Chin J Cardiovasc Med, 2020, 25(2): 156-159.
19.	Wang Z, Chen T, Ge M, et al. The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection. J Thorac Dis, 2021, 13(10): 5638-5648.

1. 中國醫師協會心血管外科分會大血管外科專業委員會. 主動脈夾層診斷與治療規范中國專家共識. 中華胸心血管外科雜志, 2017, 33(11): 641-654.The Committee of Great Vessels of Chinese Assonciation of Cardiovascular Surgeons. Chinese experts' consensus of standardized diagnosis and treatment for aortic dissection. Chin J Thorac Cardiovasc Surg, 2017, 33(11): 641–654.
2. Tadros RO, Tang GHL, Barnes HJ, et al. Optimal treatment of uncomplicated type B aortic dissection: JACC Review Topic of the Week. J Am Coll Cardiol, 2019, 74(11): 1494-1504.
3. 韓輝, 羅明堯, 舒暢. 2022年美國胸外科醫師學會/胸外科協會《B型主動脈夾層臨床診療指南》解讀. 中國胸心血管外科臨床雜志, 2022, 29(7): 820-827.Han H, Luo MY, Shu C. Interpretation of clinical practice guidelines for type B aortic dissection of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery in 2022. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(7): 820-827.
4. 李鑫, 李全明, 王倫常, 等. 主動脈夾層生物標志物的應用、探索與展望. 中華普通外科雜志, 2021, 36(4): 318-320.Li X, Li QM, Wang LC, et al. Application, exploration and prospect of biomarkers in aortic dissection. Chin J Gen Surg, 2021, 36(4): 318-320.
5. 馬倩倩, 王淑紅, 丁琦, 等. 急性主動脈夾層患者院內死亡的危險因素分析. 心肺血管病雜志, 2021, 40(5): 468-472.Ma QQ, Wang SH, Ding Q, et al. Risk factors for in-hospital mortality in patients with acute aortic dissection. J Cardiovasc Pulm Dis, 2021, 40(5): 468-472.
6. 張煥耀, 吳浩龍. 急性主動脈夾層患者院內死亡的危險因素分析. 內科, 2018, 13(4): 672-674.Zhang HY, Wu HL. Analysis of risk factors for in-hospital mortality in patients with acute aortic dissection. Intern Med, 2018, 13(4): 672-674.
7. 李末寒, 陳一歡, 吳云, 等. 急性主動脈夾層患者住院期間死亡的預警評分. 中國急救醫學, 2020, 40(11): 1065-1071.Li MH, Chen YH, Wu Y, et al. Early warning score for in-hospital mortality in the patients with acute aortic dissection. Chin J Crit Care Med, 2020, 40(11): 1065-1071.
8. 張煒宗, 馬翔, 袁紅, 等. 主動脈夾層患者院內死亡的Bayes判別分析研究. 中國全科醫學, 2019, 22(21): 2571-2576.Zhang WZ, Ma X, Yuan H, et al. Bayes discriminant analysis for in-hospital death of aortic dissection. Chin Gen Pract, 2019, 22(21): 2571-2576.
9. 陳璟, 何軍. 主動脈夾層患者院內死亡危險因素18年回顧性分析. 中國全科醫學, 2020, 23(32): 4091-4095.Chen J, He J. Risk factors for in-hospital mortality in aortic dissection: a 18-year retrospective study. Chin Gen Pract, 2020, 23(32): 4091-4095.
10. Wang M, Luo L, Xia X, et al. A simple model predicting in-hospital death in patients with type A acute aortic dissection. Perfusion, 2022, 37(8): 847-851.
11. Chi Q, He Y, Luan Y, et al. Numerical analysis of wall shear stress in ascending aorta before tearing in type A aortic dissection. Comput Biol Med, 2017, 89: 236-247.
12. 寧世鋒, 易東, 鄢華. 急性Stanford A型主動脈夾層累及冠狀動脈診療進展. 中國循證心血管醫學雜志, 2022, 14(1): 124-126.Ning SF, Yi D, Yan H. Progress in diagnosis and treatment of acute Stanford type A aortic dissection involving coronary arteries. Chin J Evid Based Cardiovasc Med, 2022, 14(1): 124-126.
13. 薛昱, 韓青松, 鞏勇智, 等. 主動脈夾層近心端不同破口形態下的血流動力學分析. 醫用生物力學, 2021, 36(5): 751-756.Xue Y, Han QS, Gong YZ, et al. Hemodynamic analysis on proximal end of the aortic dissection with different rupture shapes. J Med Biomech, 2021, 36(5): 751-756.
14. 李艷麗, 高晴云, 馮俊波, 等. Stanford A型主動脈夾層手術死亡風險因素分析. 中華全科醫學, 2022, 20(1): 18-21, 103.Li YL, Gao QY, Feng JB, et al. The death risk factors of Stanford A aortic dissection surger. Chin J Gen Pract, 2022, 20(1): 18-21, 103.
15. Kimura S, Sato H, Shimajiri S, et al. An acute aortic dissection prognostic score for predicting early in-hospital mortality in acute thoracic aortic dissection. Am Heart J Plus, 2025, 52: 100521.
16. Luo YX, Matniyaz Y, Tang YX, et al. Postoperative hyper-inflammation as a predictor of poor outcomes in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair. J Cardiothorac Surg, 2024, 19(1):138.
17. Zhang Y, Xu X, Lu Y, et al. Preoperative uric acid predicts in-hospital death in patients with acute type A aortic dissection. J Cardiothorac Surg, 2020, 15(1): 21.
18. 孫芳, 宋曉春, 陳永銘, 等. 急性Stanford A型主動脈夾層術后早期死亡因素分析. 中國心血管雜志, 2020, 25(2): 156-159.Sun F, Song XC, Chen YM, et al. Analysis of risk factors of early postoperative death in patients with acute Stanford type A aortic dissection. Chin J Cardiovasc Med, 2020, 25(2): 156-159.
19. Wang Z, Chen T, Ge M, et al. The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection. J Thorac Dis, 2021, 13(10): 5638-5648.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for perioperative mortality in acute aortic dissection and the construction of a Nomogram prediction model

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