Circulating biomarker-based risk stratifications individualize arch repair strategy of acute Type A aortic dissection via the XGBoosting algorithm
Year: 2022
Type: article
Study design: Observational Study
Abstract: Aims The incremental usefulness of circulating biomarkers from different pathological pathways for predicting mortality has not been evaluated in acute Type A aortic dissection (ATAAD) patients. We aim to develop a risk prediction model and investigate the impact of arch repair strategy on mortality based on distinct risk stratifications. Methods and results A total of 3771 ATAAD patients who underwent aortic surgery retrospectively included were randomly divided into training and testing cohorts at a ratio of 7:3 for the development and validation of the risk model based on multiple circulating biomarkers and conventional clinical factors. Extreme gradient boosting was used to generate the risk models. Subgroup analyses were performed by risk stratifications (low vs. middle–high risk) and arch repair strategies (proximal vs. extensive arch repair). Addition of multiple biomarkers to a model with conventional factors fitted an ABC risk model consisting of platelet–leucocyte ratio, mean arterial pressure, albumin, age, creatinine, creatine kinase-MB, haemoglobin, lactate, left ventricular end-diastolic dimension, urea nitrogen, and aspartate aminotransferase, with adequate discrimination ability {area under the receiver operating characteristic curve (AUROC): 0.930 [95% confidence interval (CI) 0.906–0.954] and 0.954, 95% CI (0.930–0.977) in the derivation and validation cohort, respectively}. Compared with proximal arch repair, the extensive repair was associated with similar mortality risk among patients at low risk [odds ratio (OR) 1.838, 95% CI (0.559–6.038); P = 0.316], but associated with higher mortality risk among patients at middle–high risk [OR 2.007, 95% CI (1.460–2.757); P < 0.0001]. Conclusion In ATAAD patients, the simultaneous addition of circulating biomarkers of inflammatory, cardiac, hepatic, renal, and metabolic abnormalities substantially improved risk stratification and individualized arch repair strategy.
Institutions: Jiangsu Province Hospital, Capital Medical University, Beijing Anzhen Hospital, Beijing Chao-Yang Hospital, Capital Medical University, First Affiliated Hospital of Guangzhou Medical University, First Affiliated Hospital of Shantou University Medical College, Nanjing First Hospital, Nanjing Medical University, Affiliated Hospital of Qingdao University, Xiamen University, Chinese Academy of Medical Sciences & Peking Union Medical College, TEDA International Cardiovascular Hospital, Central South University, Xiangya Hospital Central South University, Tongji University, Shanghai East Hospital, Tianjin Chest Hospital, Tianjin Medical University, First Affiliated Hospital of Bengbu Medical College, Guilin Medical University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,150
Award: G6947202522
OpenAlex ID: W4308023751