Prediction Model For Postoperative Severe Acute Lung Injury In Patients Undergoing Acute Type A Aortic Dissection Surgery

Objective:This study aimed to establish a risk assessment model to predict postoperative severe acute lung injury(ALI)risk in patients with acute type A aortic dissection(ATAAD).Methods:Consecutive patients with ATAAD admitted to our hospital were included in this retrospective assessment and placed in the severe ALI and postoperative non-severe ALI groups based on the presence or absence of ALI within 72 h postoperatively(oxygen index(OI)≤100 mmHg).Patients were then randomly divided into training and validation groups in a ratio of 8:2.Logistic regression analyses were used to statistically assess data and establish the prediction model.The prediction model’s effectiveness was evaluated via tenfold cross-validation of the validation group to facilitate construction of a nomogram.Results:After screening,479 patients were included in the study:132(27.6%)in the postoperative severe ALI group and 347(72.4%)in the postoperative non-severe ALI group.Based on logistics regression analyses,the following variables were included in the model:coronary artery disease(CAD),cardiopulmonary bypass(CPB)≥257.5 min left atrium(LA)diameter>35.5 mm,hemoglobin≤139.5 g/L,preCPB OI≤100 mmHg,intensive care unit(ICU)OI≤100 mmHg,left ventricular posterior wall thickness(LVPWT)≥10.5 mm and neutrophilic granulocyte percentage(NEUT)≥0.824.The area under the receiver operating characteristic(ROC)curve of the modeling group was 0.805,and differences between observed and predicted values were not deemed statistically significant via the Hosmer-Lemeshow test(χ2=6.037,df=8,P=0.643).For the validation group,the area under the ROC curve was 0.778,and observed and predicted value differences were insignificant when assessed using the Hosmer-Lemeshow test(χ2=3.3782,df=7;P=0.848).The average tenfold cross-validation score was 0.756.Conclusions:This study established a prediction model and developed a nomogram to determine the risk of postoperative severe ALI after ATAAD.Variables used in the model were easy to obtain clinically and the effectiveness of the model was good.