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; Nomogram

DOI：

10.7507/1007-4848.202403006

Video：

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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. 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=0.218, 95%CI (0.108, 0.440), 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.

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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
15.	劉躍, 徐宇, 李玥錦, 等. Stanford A型主動脈夾層術后早期死亡危險因素meta分析. 轉化醫學雜志, 2023, 12(2): 109-116.
16.	周陽, 柴湘平, 楊貴芳, 等. 炎性指標在急性A型主動脈夾層中不同性別患者中的差異及與院內病死率的相關性. 中國急救醫學, 2019, 39(4): 351-354.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
15. 劉躍, 徐宇, 李玥錦, 等. Stanford A型主動脈夾層術后早期死亡危險因素meta分析. 轉化醫學雜志, 2023, 12(2): 109-116.
16. 周陽, 柴湘平, 楊貴芳, 等. 炎性指標在急性A型主動脈夾層中不同性別患者中的差異及與院內病死率的相關性. 中國急救醫學, 2019, 39(4): 351-354.
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.
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

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