Development of a Predictive Model for Acute Kidney Disease Following Stanford Type A Aortic Dissection Surgery

Background: About 1/3 of Stanford type A aortic dissection (TAAD) patients with postoperative acute kidney injury (AKI) progress to acute kidney disease (AKD). Lack of validated predictive tools impedes timely intervention during renal recovery. Methods: This retrospective cohort included 290 TAAD patients with postoperative AKI after TAAD surgery. Based on serum creatinine (Scr) levels at 7 days post-AKI diagnosis, patients were categorized into AKD (n=134) and non-AKD (n=156) groups. Multivariable logistic regression identified predictors; a nomogram was constructed. Results: AKD incidence was 46.2% (134/290). Cohort characteristics were 74.8% male, mean age 52.3±11.6 years. The AKD group demonstrated higher preoperative white blood cell counts (11.61×109/L vs 11.35×109/L,P=0.045), uric acid levels (339.00 μmol/L vs 335.00 μmol/L,P=0.013), and rates of renal malperfusion (64.9% vs 50.6%,P=0.014), AKI stage 3 (55.2% vs 10.9%, P<0.001), and prolonged mechanical ventilation (87.3% VS 67.4%,P<0.001), and lower postoperative digoxin use (21.0% vs 44.9%, P<0.001). Independent predictors (Table 1) included preoperative renal malperfusion (OR=2.41,95% CI 1.16-5.01), AKI stage 2 (OR=4.38, 95% CI 2.02-9.50), AKI stage 3 (OR=18.70, 95% CI 7.39-47.17), and prolonged mechanical ventilation (OR=3.57, 95% CI 1.56-8.18). Digoxin use showed a protective effect (OR=0.46, 95% CI 0.23-0.92). The nomogram （Fig 1）demonstrated strong discrimination (AUC=0.842) and calibration (Brier score=0.160, χ2=6.48, P=0.594). Conclusion: Our nomogram enables early risk stratification to guide personalized management. Postoperative AKD independent predictors in Stanford Type A Aortic Dissection - Independent predictors OR P 95%CI Renal malperfusion 2.409 0.019 1.158~5.011 AKI stage 2 4.381 ＜0.001 2.020~9.500 AKI stage 3 18.669 ＜0.001 7.388~47.174 Digoxin use 0.459 0.028 0.229~0.919 Prolonged mechanical ventilation 3.568 0.003 1.556~8.182