Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing China.
Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
Heart Surg Forum. 2021 Apr 23;24(2):E379-E386. doi: 10.1532/hsf.3765.
This study aims to figure out risk factors of in-hospital preoperative rupture of hyperacute type A aortic dissection (haTAAD) patients and build a prediction and risk stratification model.
From January 2011 to December 2019, 830 patients diagnosed as haTAAD from Nanjing Drum Tower Hospital were enrolled. Among them, 799 patients received prompt surgery and 31 suffered aortic rupture before operation. The association between in-hospital preoperative rupture and perioperative parameters were examined. Best subset selection was used for feature selection and ROC curve was used to identify the model.
Age, winter season, back pain, preoperative hypotension, albumin and globulin ratio, high serum phosphorus level are risk factors for in-hospital preoperative rupture of haTAAD. On the basis of six variables with AUC 0.828, a nomogram was established. According to the robustness test, actual in-hospital preoperative ruptures were fitted well.
The in-hospital rupture prediction model was developed using logistic regression analysis. High serum phosphorus level is one of the strongest predictors. This nomogram may be useful when evaluating the risk of aortic dissection in-hospital rupture in future trials.
本研究旨在探讨超急型主动脉夹层（haTAAD）患者院内术前破裂的危险因素，并建立预测和风险分层模型。
2011 年 1 月至 2019 年 12 月，南京鼓楼医院共收治 830 例 haTAAD 患者，其中 799 例行急诊手术，31 例术前发生主动脉破裂。对院内术前破裂与围手术期参数的相关性进行了检验。采用最佳子集选择法进行特征选择，ROC 曲线识别模型。
年龄、冬季、背痛、术前低血压、白蛋白与球蛋白比值、高血清磷水平是 haTAAD 院内术前破裂的危险因素。基于 AUC 为 0.828 的六个变量，建立了一个列线图。通过稳健性检验，实际的院内术前破裂拟合良好。
使用逻辑回归分析建立了院内破裂预测模型。高血清磷水平是最强的预测因素之一。在未来的试验中，该列线图可能有助于评估主动脉夹层院内破裂的风险。
