Prognostic dynamic nomogram integrated with metabolic acidosis for in-hospital mortality and organ malperfusion in acute type B aortic dissection patients undergoing thoracic endovascular aortic repair

BMC Cardiovascular Disorders

Weijie Liu¹  Jitao Liu²  Qingshan Geng²  Jianfang Luo³  Ruixin Fan⁴  Hongke Zeng⁵  Fan Yang⁵  Wentao Ma⁶  Hong Liang⁶  Lyufan Chen⁶ 

[1] Center for Information Technology and Statistics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China;Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China;Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China;The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China;Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China;Department of Emergency and Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, #96 Dongchuan Road, Yuexiu District, 510080, Guangzhou, Guangdong, People’s Republic of China;School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China;

关键词: Acute type B aortic dissection;    Thoracic endovascular aortic repair;    Nomogram;    Base excess;    Malperfusion;   

DOI  :  10.1186/s12872-021-01932-8

来源: Springer

【 摘 要 】

BackgroundOrgan malperfusion is a lethal complication in acute type B aortic dissection (ATBAD). The aim of present study is to develop a nomogram integrated with metabolic acidosis to predict in-hospital mortality and organ malperfusion in patients with ATBAD undergoing thoracic endovascular aortic repair (TEVAR).MethodsThe nomogram was derived from a retrospectively study of 286 ATBAD patients who underwent TEVAR from 2010 to 2017 at a single medical center. Model performance was evaluated from discrimination and calibration capacities, as well as clinical effectiveness. The results were validated using a prospective study on 77 patients from 2018 to 2019 at the same center.ResultsIn the multivariate analysis of the derivation cohort, the independent predictors of in-hospital mortality and organ malperfusion identified were base excess, maximum aortic diameter ≥ 5.5 cm, renal dysfunction, D-dimer level ≥ 5.44 μg/mL and albumin amount ≤ 30 g/L. The penalized model was internally validated by bootstrapping and showed excellent discriminatory (bias-corrected c-statistic, 0.85) and calibration capacities (Hosmer–Lemeshow P value, 0.471; Brier Score, 0.072; Calibration intercept, − 0.02; Slope, 0.98). After being applied to the external validation cohort, the model yielded a c-statistic of 0.86 and Brier Score of 0.097. The model had high negative predictive values (0.93–0.94) and moderate positive predictive values (0.60–0.71) for in-hospital mortality and organ malperfusion in both cohorts.ConclusionsA predictive nomogram combined with base excess has been established that can be used to identify high risk ATBAD patients of developing in-hospital mortality or organ malperfusion when undergoing TEVAR.

【 授权许可】

CC BY