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, 劉金新, 趙庭浩, 等. 單中心急性B型主動脈夾層患者行急診胸主動脈腔內修復術近遠期療效分析. 臨床軍醫雜志, 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, 李響, 趙麗云. 急性Stanford A型主動脈夾層患者行急診手術后應用連續性腎臟替代治療的危險因素分析. 中華胸心血管外科雜志, 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.
13.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 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, 衛金花, 陳祖君, 等. 急性Stanford A型主動脈夾層術后中重度急性腎損傷、院內死亡及透析依賴的危險因素分析. 中國循環雜志, 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.	陳司奇, 魏翔, 陳太強. Stanford A型主動脈夾層患者孫氏手術后早期截癱原因分析. 臨床心血管病雜志, 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.	劉海淵, 高晴云, 張成鑫, 等. Stanford A型主動脈夾層術后ICU停留時間延長風險因素分析. 中華全科醫學, 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, 黃志勇. 降鈣素原對急性Stanford A型主動脈夾層患者術后感染的診斷價值. 臨床麻醉學雜志, 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, 張曉花, 湛守青. Ramsay鎮靜評分法在主動脈夾層病人孫氏手術后監護中的應用效果. 中西醫結合心腦血管病雜志, 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, 劉金新, 趙庭浩, 等. 單中心急性B型主動脈夾層患者行急診胸主動脈腔內修復術近遠期療效分析. 臨床軍醫雜志, 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, 李響, 趙麗云. 急性Stanford A型主動脈夾層患者行急診手術后應用連續性腎臟替代治療的危險因素分析. 中華胸心血管外科雜志, 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.
13. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 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, 衛金花, 陳祖君, 等. 急性Stanford A型主動脈夾層術后中重度急性腎損傷、院內死亡及透析依賴的危險因素分析. 中國循環雜志, 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. 陳司奇, 魏翔, 陳太強. Stanford A型主動脈夾層患者孫氏手術后早期截癱原因分析. 臨床心血管病雜志, 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. 劉海淵, 高晴云, 張成鑫, 等. Stanford A型主動脈夾層術后ICU停留時間延長風險因素分析. 中華全科醫學, 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, 黃志勇. 降鈣素原對急性Stanford A型主動脈夾層患者術后感染的診斷價值. 臨床麻醉學雜志, 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, 張曉花, 湛守青. Ramsay鎮靜評分法在主動脈夾層病人孫氏手術后監護中的應用效果. 中西醫結合心腦血管病雜志, 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

Latest ArticlesConstruction and validation of a dynamic prediction model for postoperative paraplegia in patients with Stanford type A aortic dissection: based on LASSO-logistic regression model

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