Construction and validation of a dynamic prediction model for postoperative paraplegia in patients with Stanford type A aortic dissection: based on LASSO-logistic regression model_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

Ni Jingxian ,  Geng Dandan , Si Linjie

Department of Cardiovascular Surgery Intensive Care, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210000, P. R. China;

Corresponding author：

Geng Dandan, Email: gengdandan1988@126.com

Keywords：

Stanford Type A aortic dissection; paraplegia; risk factors; dynamic nomogram model

DOI：

10.7507/1007-9424.202508073

Video：

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Objective To explore the risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection and to construct a nomogram prediction model for postoperative paraplegia in these patients. Methods Stanford type A aortic dissection patients admitted to the First Affiliated Hospital with Nanjing Medical University from January 2021 to August 2024 were selected as the research subjects, and the occurrence of postoperative paraplegia was statistically analyzed. LASSO regression was used to screen the predictive factors, and further multivariate Logistic regression analysis was conducted to identify the independent risk factors. A nomogram model was constructed based on R software (4.2.3), and internal validation was performed using the Bootstrap method. Results A total of 353 patients with Stanford type A aortic dissection were included, among whom 27 (7.65%) developed paraplegia after surgery. Multivariate logistic regression analysis showed that preoperative hypotension, prolonged cardiopulmonary bypass time, prolonged aortic cross-clamping time, preoperative renal insufficiency, postoperative infection, non-type I spinal cord blood supply, and intraoperative mean arterial pressure <60mmHg were independent risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection (P<0.05). The area under the receiver operating characteristic curve of the nomogram model was 0.920 [95% CI (0.879, 0.961)]; the calibration curve showed that the predicted values of the nomogram model were basically consistent with the actual values (Hosmer-Lemeshow test, χ²=3.201, P=0.921); the decision curve analysis showed that within the threshold probability range of 1% to 100%, the nomogram prediction results had good benefit values for the intervention of postoperative paraplegia in patients with Stanford type A aortic dissection. Conclusion Preoperative hypotension, prolonged cardiopulmonary bypass time, prolonged aortic cross-sectional time, renal insufficiency, postoperative infection, non-type I spinal cord blood supply, and intraoperative mean arterial pressure <60 mmHg are all independent risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection. The nomogram model constructed based on the above risk factors can effectively predict the postoperative paraplegia risk of patients with Stanford type A aortic dissection.

1.	Okada S, Hasegawa Y, Ogihara H, et al. Gallbladder necrosis after surgery for Stanford type A aortic dissection in an elderly patient: report of a case. Kyobu Geka, 2023, 76(2): 140-143.
2.	李娜, 刘金新, 赵庭浩, 等. 单中心急性B型主动脉夹层患者行急诊胸主动脉腔内修复术近远期疗效分析. 临床军医杂志, 2024, 52(12): 1223-1225.
3.	Yamamoto S, Ogawa T, Hayashida T, et al. Temporary stenting in a case of Stanford type A aortic dissection complicated with left main coronary ischemia. Gen Thorac Cardiovasc Surg, 2021, 69(1): 100-102.
4.	Liu H, Zhang S, Zhang C, et al. Risk factors for prolonged postoperative ICU stay in the patients with Stanford type A aortic dissection. J Cardiothorac Surg, 2024, 19(1): 46. doi: 10.1186/s13019-024-02548-7.
5.	林培容, 李响, 赵丽云. 急性Stanford A型主动脉夹层患者行急诊手术后应用连续性肾脏替代治疗的危险因素分析. 中华胸心血管外科杂志, 2023, 39(2): 77-81.
6.	Qin J, Mazomba M, Huang R, et al. Study on the relationship among typhoon, climate change, and acute Stanford type A aortic dissection in southern of Zhejiang in China. Gen Thorac Cardiovasc Surg, 2023, 71(2): 113-120.
7.	Sheng W, Xia W, Niu Z, et al. Incidence of acute kidney injury and risk factors of prognosis in patients with acute Stanford type A aortic dissection. Ann Thorac Cardiovasc Surg, 2023, 29(5): 249-255.
8.	De Freitas S, Rossi MJ, Abramowitz SD, et al. Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection. J Vasc Surg, 2021, 74(5): 1721-1731.
9.	Song W, Liu J, Tu G, et al. Impact of body mass index on perioperative mortality of acute Stanford type A aortic dissection: a systematic review and meta-analysis. BMC Cardiovasc Disord, 2023, 23(1): 531. doi: 10.1186/s12872-023-03517-z.
10.	Teng Cai None, Fei Z, Liu H, et al. Effect of pre-operative hypoxemia on the occurrence and outcomes of post-operative ARDS in Stanford type a aortic dissection patients. Respir Res, 2023, 24(1): 161. doi: 10.1186/s12931-023-02457-8.
11.	Kodama H, Takahashi S, Okazaki T, et al. Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(2): 226-233.
12.	中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识. 中华胸心血管外科杂志, 2017, 33(11): 641-654.
13.	中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
14.	Chen ZR, Bao MH, Wang XY, et al. Genetic variants in Chinese patients with sporadic Stanford type A aortic dissection. J Thorac Dis, 2021, 13(7): 4008-4022.
15.	Beckmann E, Martens A, Krueger H, et al. Should we operate on patients with acute type A aortic dissection who present with cardiopulmonary resuscitation?. Eur J Cardiothorac Surg, 2024, 65(3): ezae046. doi: 10.1093/ejcts/ezae046.
16.	程兆晶, 卫金花, 陈祖君, 等. 急性Stanford A型主动脉夹层术后中重度急性肾损伤、院内死亡及透析依赖的危险因素分析. 中国循环杂志, 2024, 39(6): 586-591.
17.	Kvalheim VL, Soknes MD, Jenssen GL, et al. Treatment of acute aortic dissection type A with paraplegia and distal limb ischemia within a hybrid operating room. Surg Case Rep, 2022, 8(1): 149. doi: 10.1186/s40792-022-01505-7.
18.	陈司奇, 魏翔, 陈太强. Stanford A型主动脉夹层患者孙氏手术后早期截瘫原因分析. 临床心血管病杂志, 2024, 40(9): 725-730.
19.	Kodama H, Takahashi S, Okazaki T, et al. Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(2): 226-233.
20.	刘海渊, 高晴云, 张成鑫, 等. Stanford A型主动脉夹层术后ICU停留时间延长风险因素分析. 中华全科医学, 2024, 22(7): 1125-1128.
21.	Lu S, Jiang Y, Meng F, et al. Risk factors for postoperative delirium in patients with Stanford type A aortic dissection: a systematic review and meta-analysis. J Cardiothorac Surg, 2024, 19(1): 16. doi: 10.1186/s13019-024-02485-5.
22.	白松杰, 曾冰, 黄志勇. 降钙素原对急性Stanford A型主动脉夹层患者术后感染的诊断价值. 临床麻醉学杂志, 2021, 37(1): 41-45.
23.	Bosmia AN, Hogan E, Loukas M, et al. Blood supply to the human spinal cord: part I. Anatomy and hemodynamics. Clin Anat, 2015, 28(1): 52-64.
24.	苗婷, 张晓花, 湛守青. Ramsay镇静评分法在主动脉夹层病人孙氏手术后监护中的应用效果. 中西医结合心脑血管病杂志, 2023, 21(17): 3238-3242.
25.	Torkzad MR, Koh DM. Editorial for “Development of an MRI-Based Radiomics-Clinical Model to Diagnose Liver Fibrosis Secondary to Pancreaticobiliary Maljunction in Children”. J Magn Reson Imaging, 2023, 58(2): 618-619.
26.	Wang G, Chen H, Sun P, et al. Predictive model containing gene signature and shear wave elastography to predict patient outcomes after Kasai surgery in biliary atresia. Hepatol Res, 2023, 53(11): 1126-1133.

1. Okada S, Hasegawa Y, Ogihara H, et al. Gallbladder necrosis after surgery for Stanford type A aortic dissection in an elderly patient: report of a case. Kyobu Geka, 2023, 76(2): 140-143.
2. 李娜, 刘金新, 赵庭浩, 等. 单中心急性B型主动脉夹层患者行急诊胸主动脉腔内修复术近远期疗效分析. 临床军医杂志, 2024, 52(12): 1223-1225.
3. Yamamoto S, Ogawa T, Hayashida T, et al. Temporary stenting in a case of Stanford type A aortic dissection complicated with left main coronary ischemia. Gen Thorac Cardiovasc Surg, 2021, 69(1): 100-102.
4. Liu H, Zhang S, Zhang C, et al. Risk factors for prolonged postoperative ICU stay in the patients with Stanford type A aortic dissection. J Cardiothorac Surg, 2024, 19(1): 46. doi: 10.1186/s13019-024-02548-7.
5. 林培容, 李响, 赵丽云. 急性Stanford A型主动脉夹层患者行急诊手术后应用连续性肾脏替代治疗的危险因素分析. 中华胸心血管外科杂志, 2023, 39(2): 77-81.
6. Qin J, Mazomba M, Huang R, et al. Study on the relationship among typhoon, climate change, and acute Stanford type A aortic dissection in southern of Zhejiang in China. Gen Thorac Cardiovasc Surg, 2023, 71(2): 113-120.
7. Sheng W, Xia W, Niu Z, et al. Incidence of acute kidney injury and risk factors of prognosis in patients with acute Stanford type A aortic dissection. Ann Thorac Cardiovasc Surg, 2023, 29(5): 249-255.
8. De Freitas S, Rossi MJ, Abramowitz SD, et al. Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection. J Vasc Surg, 2021, 74(5): 1721-1731.
9. Song W, Liu J, Tu G, et al. Impact of body mass index on perioperative mortality of acute Stanford type A aortic dissection: a systematic review and meta-analysis. BMC Cardiovasc Disord, 2023, 23(1): 531. doi: 10.1186/s12872-023-03517-z.
10. Teng Cai None, Fei Z, Liu H, et al. Effect of pre-operative hypoxemia on the occurrence and outcomes of post-operative ARDS in Stanford type a aortic dissection patients. Respir Res, 2023, 24(1): 161. doi: 10.1186/s12931-023-02457-8.
11. Kodama H, Takahashi S, Okazaki T, et al. Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(2): 226-233.
12. 中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识. 中华胸心血管外科杂志, 2017, 33(11): 641-654.
13. 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
14. Chen ZR, Bao MH, Wang XY, et al. Genetic variants in Chinese patients with sporadic Stanford type A aortic dissection. J Thorac Dis, 2021, 13(7): 4008-4022.
15. Beckmann E, Martens A, Krueger H, et al. Should we operate on patients with acute type A aortic dissection who present with cardiopulmonary resuscitation?. Eur J Cardiothorac Surg, 2024, 65(3): ezae046. doi: 10.1093/ejcts/ezae046.
16. 程兆晶, 卫金花, 陈祖君, 等. 急性Stanford A型主动脉夹层术后中重度急性肾损伤、院内死亡及透析依赖的危险因素分析. 中国循环杂志, 2024, 39(6): 586-591.
17. Kvalheim VL, Soknes MD, Jenssen GL, et al. Treatment of acute aortic dissection type A with paraplegia and distal limb ischemia within a hybrid operating room. Surg Case Rep, 2022, 8(1): 149. doi: 10.1186/s40792-022-01505-7.
18. 陈司奇, 魏翔, 陈太强. Stanford A型主动脉夹层患者孙氏手术后早期截瘫原因分析. 临床心血管病杂志, 2024, 40(9): 725-730.
19. Kodama H, Takahashi S, Okazaki T, et al. Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(2): 226-233.
20. 刘海渊, 高晴云, 张成鑫, 等. Stanford A型主动脉夹层术后ICU停留时间延长风险因素分析. 中华全科医学, 2024, 22(7): 1125-1128.
21. Lu S, Jiang Y, Meng F, et al. Risk factors for postoperative delirium in patients with Stanford type A aortic dissection: a systematic review and meta-analysis. J Cardiothorac Surg, 2024, 19(1): 16. doi: 10.1186/s13019-024-02485-5.
22. 白松杰, 曾冰, 黄志勇. 降钙素原对急性Stanford A型主动脉夹层患者术后感染的诊断价值. 临床麻醉学杂志, 2021, 37(1): 41-45.
23. Bosmia AN, Hogan E, Loukas M, et al. Blood supply to the human spinal cord: part I. Anatomy and hemodynamics. Clin Anat, 2015, 28(1): 52-64.
24. 苗婷, 张晓花, 湛守青. Ramsay镇静评分法在主动脉夹层病人孙氏手术后监护中的应用效果. 中西医结合心脑血管病杂志, 2023, 21(17): 3238-3242.
25. Torkzad MR, Koh DM. Editorial for “Development of an MRI-Based Radiomics-Clinical Model to Diagnose Liver Fibrosis Secondary to Pancreaticobiliary Maljunction in Children”. J Magn Reson Imaging, 2023, 58(2): 618-619.
26. Wang G, Chen H, Sun P, et al. Predictive model containing gene signature and shear wave elastography to predict patient outcomes after Kasai surgery in biliary atresia. Hepatol Res, 2023, 53(11): 1126-1133.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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