Prediction of Acute Kidney Injury for Acute Type A Aortic Dissection Patients Who Underwent Sun’s Procedure by a Perioperative Nomogram

Postoperative acute kidney injury (AKI) occurs in 20-40% of acute type A aortic dissection (ATAAD) patients undergoing cardiac surgery. A predictive model could be developed to assess the probability of AKI in patients with ATAAD before and after cardiac surgery in a timely manner.This retrospective study enrolled a total of 224 patients with ATAAD. Patients were subjected to total arch replacement using a tetrafurcate graft with stented elephant trunk implantation according to Sun's procedure. Statistical comparison for the collected data was done with Student's t test or Mann-Whitney U test (continuous variables) and χ2 test (categorical variables). The independent predictors were screened by multivariate logistic regression analysis and then incorporated into a nomogram. The reliability of cardiac surgery-associated AKI (CSA-AKI) models was evaluated using the area under the receiver operating characteristic curve (AUC).This study enrolled 224 ATAAD patients, including 53 patients with AKI and 171 patients without AKI. The incidence of ATAAD-induced AKI in the cohort was 23.66%. The screened predictors for AKI include iliac artery involvement, creatinine, D-dimer, autotransfusion, platelet-rich plasma reinfusion, nasal temperature, red blood cells, fresh frozen plasma, drainage, and mechanical ventilation. The calculated AUC values for model 1, model 2, model 3, and model 4 were 0.710, 0.777, 0.827, and 0.848, respectively. Model 4 was optimum for AKI risk scoring compared with model 1, model 2, and model 3.AKI prediction models were established for ATAAD patients using preoperative, intraoperative, and postoperative information. Particularly, model 4 shows superiority in risk prediction for CSA-AKI.