Prediction of in-hospital death following acute type A aortic dissection

Abstract

Background: Our goal was to create a prediction model for in-hospital death in Chinese patients with acute type A aortic dissection (ATAAD).

Methods: A retrospective derivation cohort was made up of 340 patients with ATAAD from Tianjin, and the retrospective validation cohort was made up of 153 patients with ATAAD from Nanjing. For variable selection, we used least absolute shrinkage and selection operator analysis, and for risk scoring, we used logistic regression coefficients. We categorized the patients into low-, middle-, and high-risk groups and looked into the correlation with in-hospital fatalities. We established a risk classifier based on independent baseline data using a multivariable logistic model. The prediction performance was determined based on the receiver operating characteristic curve (ROC). Individualized clinical decision-making was conducted by weighing the net benefit in each patient by decision curve analysis (DCA).

Results: We created a risk prediction model using risk scores weighted by five preoperatively chosen variables [AUC: 0.7039 (95% CI, 0.643-0.765)]: serum creatinine (Scr), D-dimer, white blood cell (WBC) count, coronary heart disease (CHD), and blood urea nitrogen (BUN). Following that, we categorized the cohort's patients as low-, intermediate-, and high-risk groups. The intermediate- and high-risk groups significantly increased hospital death rates compared to the low-risk group [adjusted OR: 3.973 (95% CI, 1.496-10.552), P < 0.01; 8.280 (95% CI, 3.054-22.448), P < 0.01, respectively). The risk score classifier exhibited better prediction ability than the triple-risk categories classifier [AUC: 0.7039 (95% CI, 0.6425-0.7652) vs. 0.6605 (95% CI, 0.6013-0.7197); P = 0.0022]. The DCA showed relatively good performance for the model in terms of clinical application if the threshold probability in the clinical decision was more than 10%.

Conclusion: A risk classifier is an effective strategy for predicting in-hospital death in patients with ATAAD, but it might be affected by the small number of participants.

Keywords: acute type A aortic dissection; biomarker; in-hospital death; prediction model; risk prediction.