Perioperative Risk Factors Analysis And Prediction Model Construction For 30 Days Of Death After Surgery For Acute Stanford Type A Aortic Dissection

Objective:By analyzing an examination of Acute Stanford type A aortic dissection(ATAAD)patients’perioperative data,to identify independent risk factors for death within 30days of surgical treatment,construct prediction models,plot the corresponding column line graphs,and help clinicians provide targeted treatment options to improve patient outcomes.Method:Patients with ATAAD who underwent surgical treatment from January 2017 to September 2021 were included in this study,and 151 patients were screened by nano-exclusion criteria and finally included in the study.Independent risk factors for death at 30 days after surgery in ATAAD patients were analyzed by univariate analysis and logistic regression,and prediction models were constructed and plotted in columns,and the prediction models were also evaluated.Results:1.151 patients were included in this study,26 patients were placed in the death group and 125 in the survival group,with a mortality rate of 17.2%at 30 days after surgery.By t-test,non-parametric test orχ~2test,we found that patients in both groups had a higher mortality rate in both groups in terms of leukocytes,platelets,aspartate aminotransferase(AST),blood creatinine,blood urea(Urea),myoglobin(MYO),LDL-C/HDL-C,total time of extracorporeal circulation,partial diversion time,intraoperative red blood cell transfusion,postoperative hemoglobin,postoperative platelets,postoperative AST,postoperative alanine aminotransferase(ALT),postoperative lactate dehydrogenase,postoperative Crea,postoperative Urea,postoperative HDL-C,postoperative LDL-C,postoperative platelet to neutrophil ratio(PNR),postoperative neutrophil to HDL-cholesterol ratio(NHR),and postoperative monocyte to HDL-cholesterol ratio(MHR)had statistically significant(P<0.05).2.Single factor Logistics regression analysis showed that preoperative WBC,preoperative PLT,preoperative Urea,total extracorporeal circulation time,partial diversion time,intraoperative red blood cell transfusion volume,postoperative platelets,postoperative blood creatinine,postoperative Urea,postoperative HDL-C,postoperative PNR,postoperative NHR,and postoperative MHR were correlated with patient death at 30 days postoperatively(P<0.05).Multifactorial logistic regression analysis showed that the levels of preoperative WBC,preoperative PLT,preoperative Urea,and postoperative HDL-C were independent risk factors for death at 30 days postoperatively in patients with ATAAD(P<0.05).3.A prediction model was developed and column line plots were drawn based on the screened variables,ROC curves were plotted,and AUC value of 0.908(95%CI:0.848-0.967)was calculated.The goodness-of-fit test result wasχ~2=5.073,P=0.750.Calibration curve showed good model calibration.analysis of DCA curve and CIC curve showed good clinical validity when the threshold probability was>8%.Conclusion:1.In patients undergoing surgery for ATAAD,preoperative white blood cells,preoperative platelet,preoperative urea and postoperative HDL-C are independent risk factors for their 30-day mortality risk,which should be paid close attention in the clinic.2.The prediction model constructed in this study for the risk of death at 30 days after surgery in ATAAD patients has good predictive ability and has good clinical application value.