Prediction of Postoperative Acute Kidney Injury Risk Factors for Acute Type A Aortic Dissection Patients after Modified Triple-Branched Stent Graft Implantation by a Perioperative Nomogram: A Retrospective Study

Abstract

Objective. Predicting risk factors for acute kidney injury (AKI) after total arch replacement via modified triple-branched stent graft (MTBSG) implantation in patients with acute type A aortic dissection (AAAD) by conducting a nomogram. Methods. We collected the clinical data of 254 patients with AAAD who underwent MTBSG implantation surgery in our center. The independent risk factors of postoperative AKI were screened by univariate and multivariate logistic regression analysis and combined into a nomogram. We use receiver operating characteristic (ROC) curves, decision curve analysis (DCA), clinical impact curve (CIC), and calibration plots to evaluate the accuracy of the nomogram model. Results. Multiple logistic regression analysis showed that the risk factors of AKI after MTBSG implantation were age, malperfusion syndrome, preoperative serum creatinine, cardiopulmonary bypass time, and amount of red blood cell (RBC) transfusion. Based on these five risk factors, we established a nomogram model. The good accuracy and clinical applicability of the model were verified by drawing ROC curve (area under the curve (AUC) = 0.854), DCA curve, CIC curve, and calibration curve. Conclusions. Using perioperative clinical data to establish a nomogram model of AKI in patients with AAAD who received MTBSG implantation can be used as a tool to predict the occurrence of AKI after operation.