{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:58:57Z","timestamp":1759798737660,"version":"build-2065373602"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Joint Funds for the innovation of science and Technology, Fujian province","award":["2023Y9155"],"award-info":[{"award-number":["2023Y9155"]}]},{"name":"Fujian Provincial Center for Cardiovascular Medicine Construction Project","award":["2128300201"],"award-info":[{"award-number":["2128300201"]}]},{"name":"Fujian Provincial Natural Science Foundation of China","award":["2024J01123691"],"award-info":[{"award-number":["2024J01123691"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Preoperative inflammatory biomarker ratios to predict adverse outcomes in patients with acute type A aortic dissection (AAD) were assessed in this study, and a prognostic nomogram to guide anti-inflammatory therapy was developed..<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We retrospectively analyzed 673 adult AAD patients who underwent surgery. Preoperative hematological parameters, including neutrophil, lymphocyte, and platelet counts; hemoglobin (Hb) and albumin levels; and composite indices including the neutrophil\u2012lymphocyte ratio (NLR), platelet\u2012lymphocyte ratio, neutrophil\u2012platelet ratio, and platelet\u2012albumin ratio, were evaluated. The univariate and multivariate logistic regression identified in-hospital mortality predictors, and a nomogram was constructed. The internal validation included bootstrapping with discrimination assessed by the C-index and calibration by the Hosmer\u2013Lemeshow test.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The univariate analysis revealed Hb, D-dimer, blood urea nitrogen, and albumin levels; the NLR; the aortic root concomitant procedure; ventilation support time and multiple organ dysfunction syndrome (MODS) as perioperative mortality predictors; after multivariate adjustment, decreased Hb level, elevated NLR, and the presence of MODS independently predicted in-hospital mortality. The nomogram that integrated these predictors achieved a corrected C-index of 0.846 and an area under the curve of 0.843, which demonstrated strong calibration and a Hosmer\u2013Lemeshow P\u2009=\u20090.91. At the optimal probability cutoff of 0.124, the sensitivity was 77.2%, the specificity was 78.2%, and the accuracy was 78.1%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The NLR and preoperative Hb level, combined with postoperative MODS, independently predict in-hospital death in patients with AAD. Additionally, a nomogram combining these factors accurately predicts short-term mortality and aids in the personalized risk assessment and may assist in improving the prognosis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333023","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T17:24:39Z","timestamp":1759771479000},"page":"e0333023","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic nomogram integrated with inflammatory marker ratios for assessing in-hospital mortality risk in patients with acute type A aortic dissection"],"prefix":"10.1371","volume":"20","author":[{"given":"Xiao-Chai","family":"Lv","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin-feng","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min-xia","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan-ting","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9359-4754","authenticated-orcid":true,"given":"Liang-wan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"issue":"17","key":"pone.0333023.ref001","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1161\/CIRCULATIONAHA.117.031264","article-title":"Insights 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