Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Front Immunol. 2023 Jul 24;14:1195421. doi: 10.3389/fimmu.2023.1195421. eCollection 2023.
Postoperative acute kidney injury (pAKI) is a serious complication of Stanford type A aortic dissection (TAAD) surgery, which is significantly associated with the inflammatory response. This study aimed to explore the relationship between blood count-derived inflammatory markers (BCDIMs) and pAKI and to construct a predictive model for pAKI.
Patients who underwent TAAD surgery were obtained from our center and the Medical Information Mart for Intensive Care (MIMIC)-IV database. The differences in preoperative BCDIMs and clinical outcomes of patients with and without pAKI were analyzed. Logistic regression was used to construct predictive models based on preoperative BCDIMs or white cell counts (WCCs). The performance of the BCDIMs and WCCs models was evaluated and compared using the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), Hosmer-Lemeshow test, calibration plot, net reclassification index (NRI), integrated discrimination improvement index (IDI), and decision curve analysis (DCA). The Kaplan-Meier curves were applied to compare the survival rate between different groups.
The overall incidence of pAKI in patients who underwent TAAD surgery from our center was 48.63% (124/255). The presence of pAKI was associated with longer ventilation time, higher incidence of cerebral complications and postoperative hepatic dysfunction, and higher in-hospital mortality. The results of the logistic regression indicated that the monocyte-lymphocyte ratio (MLR) was an independent risk factor for pAKI. The BCDIMs model had good discriminating ability, predictive ability, and clinical utility. In addition, the performance of the BCDIMs model was significantly better than that of the WCCs model. Analysis of data from the MIMIC-IV database validated that MLR was an independent risk factor for pAKI and had predictive value for pAKI. Finally, data from the MIMIC-IV database demonstrated that patients with a high MLR had a significantly poor 28-day survival rate when compared to patients with a low MLR.
Our study suggested that the MLR is an independent risk factor for pAKI. A predictive model based on BCDIMs had good discriminating ability, predictive ability, and clinical utility. Moreover, the performance of the BCDIMs model was significantly better than that of the WCCs model. Finally, a high MLR was significantly associated with poor short-term survival of patients who underwent TAAD surgery.
术后急性肾损伤（pAKI）是 Stanford 型 A 型主动脉夹层（TAAD）手术的严重并发症，与炎症反应密切相关。本研究旨在探讨血常规衍生炎症标志物（BCDIMs）与 pAKI 的关系，并构建 pAKI 的预测模型。
本研究从我们的中心和医疗信息监护 IV 数据库（MIMIC-IV 数据库）中获得接受 TAAD 手术的患者。分析了有和无 pAKI 的患者术前 BCDIMs 和临床结局的差异。基于术前 BCDIMs 或白细胞计数（WCCs），采用 logistic 回归构建预测模型。使用受试者工作特征（ROC）曲线、ROC 曲线下面积（AUC）、Hosmer-Lemeshow 检验、校准图、净重新分类指数（NRI）、综合判别改善指数（IDI）和决策曲线分析（DCA）评估和比较 BCDIMs 和 WCCs 模型的性能。Kaplan-Meier 曲线用于比较不同组之间的生存率。
我们中心接受 TAAD 手术的患者中，pAKI 的总发生率为 48.63%（124/255）。pAKI 的存在与通气时间延长、脑并发症和术后肝功能障碍发生率升高以及住院死亡率升高有关。logistic 回归的结果表明单核细胞-淋巴细胞比值（MLR）是 pAKI 的独立危险因素。BCDIMs 模型具有良好的区分能力、预测能力和临床实用性。此外，BCDIMs 模型的性能明显优于 WCCs 模型。对 MIMIC-IV 数据库数据的分析表明，MLR 是 pAKI 的独立危险因素，对 pAKI 有预测价值。最后，MIMIC-IV 数据库的数据表明，与 MLR 较低的患者相比，MLR 较高的患者 28 天生存率明显较差。
本研究表明 MLR 是 pAKI 的独立危险因素。基于 BCDIMs 的预测模型具有良好的区分能力、预测能力和临床实用性。此外，BCDIMs 模型的性能明显优于 WCCs 模型。最后，高 MLR 与接受 TAAD 手术患者的短期生存不良显著相关。
Zotero 插件
