Frontiers in cardiovascular medicine · 2026
Development and validation of a clinical prediction model for postcontrast acute kidney injury in patients with postoperative acute kidney injury of acute Stanford type A aortic dissection.
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Zhao Weiwei, Ge Min, Cheng YongQing, Chen Ming, Zhou Qing, Yu Wenkui
Аннотация
OBJECTIVES: To identify independent risk factors for postcontrast acute kidney injury (PC-AKI) in patients with postoperative AKI (PO-AKI) following acute Stanford type A aortic dissection (ATAAD), and to develop a clinically applicable prediction model.
METHODS: This retrospective cohort study enrolled 604 PO-AKI patients (2014-2024, Nanjing Drum Tower Hospital) who underwent ≥1 postoperative contrast-enhanced CTA. PC-AKI was diagnosed per 2018 ESUR guidelines (sCr elevation ≥26.5 μmol/L or ≥1.5 times baseline within 48-72 h, with baseline defined as the most recent pre-CTA sCr). Three variable-selection strategies (backward stepwise AIC, LASSO and XGBoost-SHAP) were used. A multivariable logistic regression model was constructed, internally validated by bootstrap resampling (1,000 repetitions), and evaluated via AUC, calibration curves, Brier score, decision curve analysis, and clinical impact curve.
RESULTS: PC-AKI incidence was 9.8% (59/604), with striking recovery-dependent stratification: 3.5% in fully recovered PO-AKI vs. 52.5% in unrecovered PO-AKI. Independent predictors included PO-AKI stage 3 (OR = 3.144, 95% CI: 1.41-7.06) and unrecovered PO-AKI before first CTA (OR = 25.212, 95% CI: 12.57-53.49). The model exhibited good discrimination (AUC=0.848, 95% CI: 0.78-0.91) and calibration (Brier=0.057). PC-AKI was independently associated with prolonged ICU stay (RR = 1.521, 95% CI: 1.19-1.97) and incomplete renal recovery at discharge (OR = 2.554, 95% CI: 1.30-4.86), but not with 30-day mortality (P = 0.606).
CONCLUSION: Dynamic PO-AKI recovery and advanced AKI stage are strongly associated with PC-AKI risk in post-ATAAD patients. The internally validated model may aid individualized risk stratification before contrast procedures in this high-risk subgroup. External validation is needed before clinical deployment.
METHODS: This retrospective cohort study enrolled 604 PO-AKI patients (2014-2024, Nanjing Drum Tower Hospital) who underwent ≥1 postoperative contrast-enhanced CTA. PC-AKI was diagnosed per 2018 ESUR guidelines (sCr elevation ≥26.5 μmol/L or ≥1.5 times baseline within 48-72 h, with baseline defined as the most recent pre-CTA sCr). Three variable-selection strategies (backward stepwise AIC, LASSO and XGBoost-SHAP) were used. A multivariable logistic regression model was constructed, internally validated by bootstrap resampling (1,000 repetitions), and evaluated via AUC, calibration curves, Brier score, decision curve analysis, and clinical impact curve.
RESULTS: PC-AKI incidence was 9.8% (59/604), with striking recovery-dependent stratification: 3.5% in fully recovered PO-AKI vs. 52.5% in unrecovered PO-AKI. Independent predictors included PO-AKI stage 3 (OR = 3.144, 95% CI: 1.41-7.06) and unrecovered PO-AKI before first CTA (OR = 25.212, 95% CI: 12.57-53.49). The model exhibited good discrimination (AUC=0.848, 95% CI: 0.78-0.91) and calibration (Brier=0.057). PC-AKI was independently associated with prolonged ICU stay (RR = 1.521, 95% CI: 1.19-1.97) and incomplete renal recovery at discharge (OR = 2.554, 95% CI: 1.30-4.86), but not with 30-day mortality (P = 0.606).
CONCLUSION: Dynamic PO-AKI recovery and advanced AKI stage are strongly associated with PC-AKI risk in post-ATAAD patients. The internally validated model may aid individualized risk stratification before contrast procedures in this high-risk subgroup. External validation is needed before clinical deployment.