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

Objective: To screen out the risk factors of acute lung injury(ALI)after acute type A aortic dissection(ATAAD),and on this basis,establish a nomograph model of the risk of acute lung injury after type A aortic dissection and verify its feasibility.Methods: The clinical data of 89 patients who underwent surgical treatment for ATAAD at First Affiliated Hospital of the Wan Nan Medical College from January 2019 to may 2022 were collected,and the preoperative data included: age,sex(male / female),body mass index(BMI),smoking history,history of hypertension,pleural fluid,preoperative white blood cell count(WBCc),preoperative C-reactive protein(CRP),preoperative D-dimer,preoperative blood pressure(systolic and diastolic),preoperative cardiac function Ejection fraction(EF)and maximum diameter of the aorta before surgery.The following inflammatory factors were detected in the blood: interleukin 6(IL-6),interleukin 8(IL-8),interleukin 10(IL-10),interleukin 11(IL-11),tumor necrosis factor-α(TNF-α),Matrix metalloproteinase-9(MMP-9),thromboxane B2(TXB2),prostacyclin I2(PGI2),insulin-like growth factor binding proteins-7(IGFBP-7).Intraoperative data included: operative time,anesthesia time,cardiopulmonary bypass time,myocardial blocking time,hypothermia circulatory arrest time,hypothermia time,temperature nadir,intraoperative transfusion of suspended red blood cells,plasma,platelets,and autologous blood reinfusion volume.Postoperative data included: length of hospital stay,length of ICU stay,and 28 day survival.Meanwhile,2 ml of preoperative peripheral venous blood of patients was collected to detect the concentration of related inflammatory indicators.Using the 24-h postoperative oxygenation index(Pa O2 / Fi O2)as a standard grouping,the patients were divided into two groups: non-acute lung injury group(N-ALI group,Pa O2 / Fi O2 > 200 mm Hg)and acute lung injury group(ALI group,Pa O2 / Fi O2 ≤ 200 mm Hg).Binary logistic regression analysis was used to determine independent risk factors,and based on the results,indicators were selected to establish a nomogram model for predicting the risk of postoperative ALI occurrence,the consistency and accuracy of the model were verified by calibration curve and receiver operating characteristic(ROC)curve,and decision curve analysis(DCA)was used to determine the clinical usefulness of the model.Results: Forty nine(55.06%)ATAAD patients developed ALI postoperatively.Compared with the N-ALI group,the ALI group had higher preoperative WBCc,IL-10 and TNF-α,IGFBP-7 increased and prolonged ICU stay.EF,lowest intraoperative temperature decreased.Binary logistic regression analysis showed that preoperative diastolic blood pressure,time to hypothermia,preoperative IL-10,and TNF-α Level as an independent risk factor for developing ALI postoperatively.Based on binary logistic regression analysis results were expressed as diastolic blood pressure,time to hypothermia,preoperative IL-10,TNF-α Isometrics a nomogram model was constructed,which was internally validated and the calibration curve showed that the mean absolute error of the model in predicting the risk of postoperative ALI from the actual risk of postoperative ALI was 0.047;The ROC curve showed that the area under the curve of the model to predict the risk of postoperative morbidity was 0.883(95% CI 0.809-0.958),with a sensitivity of 76.20% and a specificity of89.70%;DCA analysis showed good clinical utility of the model.Conclusion:The incidence of postoperative ALI in patients with ataad was 55.06%.Preoperative diastolic blood pressure,duration of hypothermia,preoperative IL-10,and preoperative TNF-α as an independent risk factor for the development of postoperative ALI,it could predict the occurrence of postoperative ALI in patients with ataad to some extent.We constructed a nomogram model of ALI occurrence after ATAAD,which was internally validated with good utility and had better clinical application value.