Construction of a prediction model for systemic inflammatory response syndrome in patients undergoing interventional surgery for type B aortic dissection based on logistic regression and decision tree algorithm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Pingzhen , WU Guiqin , FU Yuanyuan , LIU Chunyan , DUAN Qiongyan , PAN Xiaojing , CHEN Zhouzhen , CHEN Xia

Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen, 580000, Guangdong, P. R. China;

Corresponding?author：

WU Guiqin, Email:

Keywords：

Logistic regression analysis; decision tree algorithm; type B aortic dissection; interventional surgery; systemic inflammatory response syndrome; prediction model

DOI：

10.7507/1007-4848.202505088

Video：

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Objective To construct and compare logistic regression and decision tree models for predicting systemic inflammatory response syndrome (SIRS) in patients with type B aortic dissection (TBAD) after interventional surgery. Methods A retrospective analysis was conducted on clinical data of TBAD patients at Peking University Shenzhen Hospital from 2020 to 2024. The patients were divided into a SIRS group and a non SIRS group based on whether SIRS occurred within 24 hours after surgery. Multivariate logistic regression was used to analyze the influencing factors of SIRS occurrence in TBAD intervention patients, and a decision tree model was constructed using SPSS Modeler to compare the predictive performance of the two models. Results A total of 742 patients with TBAD were included, including 579 males and 163 females, aged between 27 and 97 (58.85±10.79) years. Within 24 hours after intervention, a total of 506 patients developed SIRS, with an incidence rate of 68.19%. Logistic regression analysis showed that the extensive involvement of the dissection, the surgical time≥ 2 hours, PET coated stents implanted, serum creatinine, white blood cell count, C-reactive protein, monocyte count (MONO), neutrophil count levels elevated, estimated glomerular filtration rate and decreased albumin levels were independent risk factors for SIRS (P<0.05). The decision tree model selected a total of 10 explanatory variables and 6 layers with 37 nodes, among which MONO was the most important predictor. The area under the decision tree model curve was 0.829 [95% CI (0.800, 0.856)], which was better than the logistic regression model's 0.690 [95% CI (0.655, 0.723)], and the difference was statistically significant (P<0.001). Conclusion The incidence of SIRS after TBAD intervention is high, and the decision tree model has better predictive performance than logistic regression. It can identify high-risk patients with higher accuracy and provide a practical tool for early clinical intervention.

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2.	Zhang TT, Lei QQ, He J, et al. Bestrophin3 deficiency in vascular smooth muscle cells activates MEKK2/3-MAPK signaling to trigger spontaneous aortic dissection. Circulation, 2023, 148(7): 589-606.
3.	俞靖凡, 徐國雄, 張志軒, 等. 可擴張鞘管在復雜髂股動脈入路經皮胸主動脈腔內修復術的安全性與有效性研究. 心肺血管病雜志, 2024, 43(10): 1079-1084.Yu JF, Xu GX, Zhang ZX, et al. Study on the safety and efficacy of expandable sheath tubes in percutaneous thoracic endovascular aortic repair via complex iliofemoral artery approach. J Cardiopulm Vasc Dis, 2024, 43(10): 1079-1084.
4.	Zhao Y, Hong X, Xie X, et al. Preoperative systemic inflammatory response index predicts long-term outcomes in type B aortic dissection after endovascular repair. Front Immunol, 2022, 13(5): 992463.
5.	Chatzelas DA, Pitoulias AG, Telakis ZC, et al. Incidence and risk factors of postimplantation syndrome after elective endovascular aortic aneurysm repair. Int Angiol, 2022, 41(3): 196-204.
6.	Al-Tawil M, Geragotellis A, Jubouri M, et al. Population risk profile analysis of acute uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair. Asian Cardiovasc Thorac Ann, 2023, 31(7): 549-556.
7.	D'Oria M, Manoranjithan S, Scoville C, et al. Systematic review of risk factors and outcomes of post-implantation syndrome following endovascular aortic repair. J Vasc Surg, 2024, 79(5): 1240-1250.
8.	唐依琳, 張淥愷, 金倞, 等. 基于平掃CT三維影像組學特征的機器學習模型檢測主動脈夾層的價值. 復旦學報: 醫學版, 2023, 50(5): 723-730.Tang YL, Zhang LK, Jin L, et al. Value of machine learning model based on three-dimensional radiomics features of plain scan CT in detecting aortic dissection. Fudan Univ J Med Sci, 2023, 50(5): 723-730.
9.	Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 1992, 101(6): 1644-1655.
10.	Mannina C, Kini A, Carbone A, et al. Management of systemic inflammatory response syndrome after cardiovascular interventions. Diagnostic, prognostic, and therapeutic implications. Am J Cardiol, 2024, 221(6): 84-93.
11.	李高山, 潘文旭, 高智春, 等. Stanford B型主動脈夾層患者TEVAR術后發生植入后綜合征的危險因素. 陸軍軍醫大學學報, 2023, 45(20): 2149-2158.Li GS, Pan WX, Gao ZC, et al. Risk factors for post-implantation syndrome in patients with Stanford type B aortic dissection after TEVAR. J Third Mil Med Univ, 2023, 45(20): 2149-2158.
12.	左文霞, 胡藝蘭, 宋來春, 等. 急性Stanford A型主動脈夾層患者術后早期發生全身炎癥反應綜合征的危險因素分析及其對預后的影響. 中國心血管病研究, 2023, 21(2): 182-187.Zuo WX, Hu YL, Song LC, et al. Analysis of risk factors for early postoperative systemic inflammatory response syndrome in patients with acute Stanford type A aortic dissection and its impact on prognosis. Chin J Cardiovasc Res, 2023, 21(2): 182-187.
13.	劉勝菲, 李龍. 炎癥指標在結締組織病相關間質性肺病并發呼吸衰竭中的預測價值. 聯勤軍事醫學, 2024, 38(02): 138-143.Liu SF, Li L. Predictive value of inflammatory indicators in connective tissue disease-related interstitial lung disease complicated with respiratory failure. Jt Mil Med, 2024, 38(02): 138-143.
14.	陳勇, 廖成全, 姚世源, 等. CRP, NLR, PLT與急性主動脈夾層病人術前低氧血癥的關系及對臨床轉歸的預測價值. 中西醫結合心腦血管病雜志, 2023, 21(15): 2841-2844.Chen Y, Liao CQ, Yao SY, et al. The relationship between CRP, NLR, PLT and preoperative hypoxemia in patients with acute aortic dissection and its predictive value for clinical outcome. Chin J Integr Med Cardio Cerebrovasc Dis, 2023, 21(15): 2841-2844.
15.	陳冠戎, 陳勁巖, 胡歆, 等. 基于機器學習算法構建心臟死亡器官捐獻供肝肝移植后急性腎損傷風險預測模型的應用價值. 中華消化外科雜志, 2025, 24(2): 236-248.Chen GR, Chen JY, Hu X, et al. Application value of constructing a risk prediction model for acute kidney injury after liver transplantation based on machine learning algorithm for donor livers from cardiac death organs. Chin J Dig Surg, 2025, 24(2): 236-248.
16.	Bashir M, Tan SZ, Jubouri M, et al. Uncomplicated type B aortic dissection: challenges in diagnosis and categorization. Ann Vasc Surg, 2023, 94: 92.
17.	Zhang X, Cheng G, Han X, et al. Deep learning-based multi-stage postoperative type-b aortic dissection segmentation using global-local fusion learning. Phys Med Biol, 2023, 68(23): 112-116.
18.	薛華蓉, 劉麗艷. 高齡社區獲得性肺炎患者血清可溶性尿激酶型纖溶酶原激活物受體, 正五聚蛋白3, 中性粒細胞與淋巴細胞比值檢測及與病情嚴重程度及預后的相關性. 中華老年多器官疾病雜志, 2024, 23(2): 87-92.Xue HR, Liu LY. Detection of serum soluble urokinase-type plasminogen activator receptor, pentraxin-3, neutrophil-to-lymphocyte ratio and its correlation with disease severity and prognosis in elderly patients with community-acquired pneumonia. Chin J Mult Organ Dis Elderly, 2024, 23(2): 87-92.
19.	孫聰, 戴國華, 管慧, 等. 基于決策樹算法的慢性心力衰竭患者中西醫預后模型構建及驗證. 中國中醫基礎醫學雜志, 2023, 29(1): 120-126.Sun C, Dai GH, Guan H, et al. Construction and validation of a prognostic model for chronic heart failure patients based on decision tree algorithm using both traditional Chinese and Western medicine. Chin J Basic Med Tradit Chin Med, 2023, 29(1): 120-126.

1. Luo Y, Luo J, An P, et al. The activator protein-1 complex governs a vascular degenerative transcriptional programme in smooth muscle cells to trigger aortic dissection and rupture. Eur Heart J, 2024, 45(4): 287-305.
2. Zhang TT, Lei QQ, He J, et al. Bestrophin3 deficiency in vascular smooth muscle cells activates MEKK2/3-MAPK signaling to trigger spontaneous aortic dissection. Circulation, 2023, 148(7): 589-606.
3. 俞靖凡, 徐國雄, 張志軒, 等. 可擴張鞘管在復雜髂股動脈入路經皮胸主動脈腔內修復術的安全性與有效性研究. 心肺血管病雜志, 2024, 43(10): 1079-1084.Yu JF, Xu GX, Zhang ZX, et al. Study on the safety and efficacy of expandable sheath tubes in percutaneous thoracic endovascular aortic repair via complex iliofemoral artery approach. J Cardiopulm Vasc Dis, 2024, 43(10): 1079-1084.
4. Zhao Y, Hong X, Xie X, et al. Preoperative systemic inflammatory response index predicts long-term outcomes in type B aortic dissection after endovascular repair. Front Immunol, 2022, 13(5): 992463.
5. Chatzelas DA, Pitoulias AG, Telakis ZC, et al. Incidence and risk factors of postimplantation syndrome after elective endovascular aortic aneurysm repair. Int Angiol, 2022, 41(3): 196-204.
6. Al-Tawil M, Geragotellis A, Jubouri M, et al. Population risk profile analysis of acute uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair. Asian Cardiovasc Thorac Ann, 2023, 31(7): 549-556.
7. D'Oria M, Manoranjithan S, Scoville C, et al. Systematic review of risk factors and outcomes of post-implantation syndrome following endovascular aortic repair. J Vasc Surg, 2024, 79(5): 1240-1250.
8. 唐依琳, 張淥愷, 金倞, 等. 基于平掃CT三維影像組學特征的機器學習模型檢測主動脈夾層的價值. 復旦學報: 醫學版, 2023, 50(5): 723-730.Tang YL, Zhang LK, Jin L, et al. Value of machine learning model based on three-dimensional radiomics features of plain scan CT in detecting aortic dissection. Fudan Univ J Med Sci, 2023, 50(5): 723-730.
9. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 1992, 101(6): 1644-1655.
10. Mannina C, Kini A, Carbone A, et al. Management of systemic inflammatory response syndrome after cardiovascular interventions. Diagnostic, prognostic, and therapeutic implications. Am J Cardiol, 2024, 221(6): 84-93.
11. 李高山, 潘文旭, 高智春, 等. Stanford B型主動脈夾層患者TEVAR術后發生植入后綜合征的危險因素. 陸軍軍醫大學學報, 2023, 45(20): 2149-2158.Li GS, Pan WX, Gao ZC, et al. Risk factors for post-implantation syndrome in patients with Stanford type B aortic dissection after TEVAR. J Third Mil Med Univ, 2023, 45(20): 2149-2158.
12. 左文霞, 胡藝蘭, 宋來春, 等. 急性Stanford A型主動脈夾層患者術后早期發生全身炎癥反應綜合征的危險因素分析及其對預后的影響. 中國心血管病研究, 2023, 21(2): 182-187.Zuo WX, Hu YL, Song LC, et al. Analysis of risk factors for early postoperative systemic inflammatory response syndrome in patients with acute Stanford type A aortic dissection and its impact on prognosis. Chin J Cardiovasc Res, 2023, 21(2): 182-187.
13. 劉勝菲, 李龍. 炎癥指標在結締組織病相關間質性肺病并發呼吸衰竭中的預測價值. 聯勤軍事醫學, 2024, 38(02): 138-143.Liu SF, Li L. Predictive value of inflammatory indicators in connective tissue disease-related interstitial lung disease complicated with respiratory failure. Jt Mil Med, 2024, 38(02): 138-143.
14. 陳勇, 廖成全, 姚世源, 等. CRP, NLR, PLT與急性主動脈夾層病人術前低氧血癥的關系及對臨床轉歸的預測價值. 中西醫結合心腦血管病雜志, 2023, 21(15): 2841-2844.Chen Y, Liao CQ, Yao SY, et al. The relationship between CRP, NLR, PLT and preoperative hypoxemia in patients with acute aortic dissection and its predictive value for clinical outcome. Chin J Integr Med Cardio Cerebrovasc Dis, 2023, 21(15): 2841-2844.
15. 陳冠戎, 陳勁巖, 胡歆, 等. 基于機器學習算法構建心臟死亡器官捐獻供肝肝移植后急性腎損傷風險預測模型的應用價值. 中華消化外科雜志, 2025, 24(2): 236-248.Chen GR, Chen JY, Hu X, et al. Application value of constructing a risk prediction model for acute kidney injury after liver transplantation based on machine learning algorithm for donor livers from cardiac death organs. Chin J Dig Surg, 2025, 24(2): 236-248.
16. Bashir M, Tan SZ, Jubouri M, et al. Uncomplicated type B aortic dissection: challenges in diagnosis and categorization. Ann Vasc Surg, 2023, 94: 92.
17. Zhang X, Cheng G, Han X, et al. Deep learning-based multi-stage postoperative type-b aortic dissection segmentation using global-local fusion learning. Phys Med Biol, 2023, 68(23): 112-116.
18. 薛華蓉, 劉麗艷. 高齡社區獲得性肺炎患者血清可溶性尿激酶型纖溶酶原激活物受體, 正五聚蛋白3, 中性粒細胞與淋巴細胞比值檢測及與病情嚴重程度及預后的相關性. 中華老年多器官疾病雜志, 2024, 23(2): 87-92.Xue HR, Liu LY. Detection of serum soluble urokinase-type plasminogen activator receptor, pentraxin-3, neutrophil-to-lymphocyte ratio and its correlation with disease severity and prognosis in elderly patients with community-acquired pneumonia. Chin J Mult Organ Dis Elderly, 2024, 23(2): 87-92.
19. 孫聰, 戴國華, 管慧, 等. 基于決策樹算法的慢性心力衰竭患者中西醫預后模型構建及驗證. 中國中醫基礎醫學雜志, 2023, 29(1): 120-126.Sun C, Dai GH, Guan H, et al. Construction and validation of a prognostic model for chronic heart failure patients based on decision tree algorithm using both traditional Chinese and Western medicine. Chin J Basic Med Tradit Chin Med, 2023, 29(1): 120-126.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesConstruction of a prediction model for systemic inflammatory response syndrome in patients undergoing interventional surgery for type B aortic dissection based on logistic regression and decision tree algorithm

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