{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T17:03:08Z","timestamp":1778173388280,"version":"3.51.4"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Acute aortic dissection is a life-threatening condition, and malperfusion significantly exacerbates the prognosis of patients diagnosed with type A Acute aortic dissection (ATAAD). Current risk assessment tools often fail to consider the impact of nutritional and inflammatory factors, limiting their predictive accuracy. The aim of this study was to develop a machine learning model that integrates nutritional and inflammatory indices to predict 1-year mortality in ATAAD patients with malperfusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included 433 ATAAD patients with malperfusion from Henan Provincial Chest Hospital (August 2020 to June 2023). Four machine learning models\u2014logistic regression, XGBoost, random forest, and deep neural network\u2014were developed to predict 1-year mortality using inflammatory and nutritional laboratory values, indices, and other clinical variables. Model training employed stratified 5-fold cross-validation and SMOTE for imbalanced data. The area under the receiver operating characteristic (ROC AUC) and other performance metrics were used to evaluate model efficacy, while SHAP values were computed to interpret feature importance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 433 ATAAD patients with malperfusion, the random forest model used inflammatory and nutritional laboratory values to achieve the highest discrimination (AUC\u2009=\u20090.8242, 95% CI 0.7095\u20130.9219), while the XGBoost model performed best with inflammatory and nutritional indices (AUC\u2009=\u20090.7334, 95% CI 0.6115\u20130.8488). Calibration curves and Brier scores indicated good agreement between predicted and observed outcomes. Decision curve analysis demonstrated consistent net benefit for random forest and XGBoost models across clinically relevant threshold probabilities. Feature importance and SHAP analyses identified albumin, platelet count, total cholesterol, and C-reactive protein as consistently influential predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Nutritional and inflammatory factors significantly contribute to the 1-year mortality risk of ATAAD patients with malperfusion. Machine learning models that incorporate these factors, particularly random forest and XGBoost, can effectively stratify patient risk and support clinical decision-making. These findings underscore the importance of a comprehensive approach to risk assessment that includes metabolic and inflammatory markers to enhance patient outcomes and guide personalized interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1539267","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T05:25:24Z","timestamp":1759123524000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Machine learning-based prediction of 1-year mortality using nutritional and inflammatory factors for type A acute aortic dissection with malperfusion"],"prefix":"10.3389","volume":"12","author":[{"given":"Yanda","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Marimekala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hang","family":"Xing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Long","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"B1","article-title":"Aortic dissection","volume-title":"StatPearls [Internet]","author":"Levy","year":"2024"},{"key":"B2","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1136\/heartjnl-2015-308284","article-title":"Aortic dissection: medical, interventional and surgical management","volume":"103","author":"Silaschi","year":"2017","journal-title":"Heart"},{"key":"B3","article-title":"Acute aortic syndrome","volume-title":"StatPearls [Internet]","author":"Vignaraja","year":"2024"},{"key":"B4","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1186\/s13019-024-02790-z","article-title":"Surgical choice for the treatment of partial intestinal ischemic necrosis caused by acute type A aortic dissection combined with malperfusion of superior mesenteric artery","volume":"19","author":"Yu","year":"2024","journal-title":"J Cardiothorac Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.jacc.2015.05.029","article-title":"Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection","volume":"66","author":"Pape","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1055\/s-0036-1572436","article-title":"German registry for acute aortic dissection type A: structure, results, and future perspectives","volume":"65","author":"Boening","year":"2017","journal-title":"Thorac Cardiovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1016\/j.jtcvs.2018.10.134","article-title":"Malperfusion in acute type A aortic dissection: an update from the Nordic consortium for acute type A aortic dissection","volume":"157","author":"Zindovic","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1161\/CIRCULATIONAHA.118.036328","article-title":"Endovascular fenestration\/stenting first followed by delayed open aortic repair for acute type A aortic dissection with malperfusion syndrome","volume":"138","author":"Yang","year":"2018","journal-title":"Circulation"},{"key":"B9","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/j.jtcvs.2022.04.051","article-title":"Outcomes of emergency surgery for acute type A aortic dissection complicated by malperfusion syndrome","volume":"167","author":"Brown","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e36301","DOI":"10.7759\/cureus.36301","article-title":"Acute Stanford type A aortic dissection: a review of risk factors and outcomes","volume":"15","author":"Chukwu","year":"2023","journal-title":"Cureus"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e20220185","DOI":"10.21470\/1678-9741-2022-0185","article-title":"Postoperative prognostic nutritional index and fibrinogen could well predict poor prognosis of acute type A aortic dissection patients after surgery","volume":"39","author":"Hu","year":"2024","journal-title":"Braz J Cardiovasc Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.arr.2008.08.001","article-title":"Inflammatory response is associated with aortic dissection","volume":"8","author":"Luo","year":"2009","journal-title":"Ageing Res Rev"},{"key":"B13","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.hrtlng.2020.06.004","article-title":"Prognostic nutritional index predicts in-hospital mortality in patients with acute type A aortic dissection","volume":"50","author":"Lin","year":"2021","journal-title":"Heart Lung"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1814","DOI":"10.3390\/genes13101814","article-title":"Risk factors for thoracic aortic dissection","volume":"13","author":"Zhou","year":"2022","journal-title":"Genes (Basel)"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e230421186875","DOI":"10.2174\/1573403X16666201014142930","article-title":"Aortic dissection: a review of the pathophysiology, management and prospective advances","volume":"17","author":"Sayed","year":"2021","journal-title":"Curr Cardiol Rev"},{"key":"B16","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1097\/CM9.0000000000002719","article-title":"Biomarkers in aortic dissection: diagnostic and prognostic value from clinical research","volume":"137","author":"Zhao","year":"2024","journal-title":"Chin Med J (Engl)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/j.avsg.2020.06.026","article-title":"Identification of serum biomarker in acute aortic dissection by global and targeted metabolomics","volume":"68","author":"Zeng","year":"2020","journal-title":"Ann Vasc Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1080\/14017431.2019.1689289","article-title":"Inflammatory biomarkers to predict adverse outcomes in postoperative patients with acute type A aortic dissection","volume":"54","author":"Liu","year":"2020","journal-title":"Scand Cardiovasc J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.ancard.2020.07.012","article-title":"Serum albumin and cardiovascular disease: state-of-the-art review","volume":"69","author":"Arques","year":"2020","journal-title":"Ann Cardiol Angeiol (Paris)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"249","DOI":"10.31083\/j.rcm2507249","article-title":"Prevalence and prognostic significance of malnutrition in patients with type B aortic dissection undergoing endovascular repair","volume":"25","author":"Zhou","year":"2024","journal-title":"Rev Cardiovasc Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1428532","DOI":"10.3389\/fnut.2024.1428532","article-title":"Development of a machine learning-based model to predict major adverse events after surgery for type A aortic dissection complicated by malnutrition","volume":"11","author":"Xie","year":"2024","journal-title":"Front Nutr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1210725","DOI":"10.3389\/fcvm.2023.1210725","article-title":"Efficacy of prognostic nutrition index in combination with D-dimer in predicting postoperative clinical adverse events after acute type A aortic dissection: a single center retrospective study","volume":"10","author":"Xie","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"499","DOI":"10.31083\/j.rcm2202057","article-title":"Prognostic nutritional index as a marker of mortality: an observational cohort study of patients undergoing cardiac surgery","volume":"22","author":"Gucu","year":"2021","journal-title":"RCM"},{"key":"B24","doi-asserted-by":"publisher","first-page":"663","DOI":"10.7150\/ijms.81884","article-title":"Prognostic value of serum albumin in aortic aneurysm patients undergoing graft replacement of ascending aorta and aortic arch","volume":"20","author":"Nam","year":"2023","journal-title":"Int J Med Sci"},{"key":"B25","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1177\/0267659120961937","article-title":"Prognostic nutritional index predicts in-hospital mortality in patients with acute Stanford type A aortic dissection","volume":"36","author":"Keskin","year":"2021","journal-title":"Perfusion"},{"key":"B26","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1007\/s11748-020-01300-x","article-title":"Clinical significance of the prognostic nutritional index in patients undergoing cardiovascular surgery","volume":"68","author":"Hayashi","year":"2020","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.tcm.2018.12.003","article-title":"Imaging aortic wall inflammation","volume":"29","author":"Syed","year":"2019","journal-title":"Trends Cardiovasc Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2433","DOI":"10.3390\/cells10092433","article-title":"Inflammasomes in the pathophysiology of aortic disease","volume":"10","author":"Wortmann","year":"2021","journal-title":"Cells"},{"key":"B29","doi-asserted-by":"publisher","first-page":"22","DOI":"10.29245\/2578-3009\/2018\/4.1156","article-title":"Inflammatory mechanisms contributing to aortic expansion and rupture after acute aortic dissection","volume":"2","author":"Anzai","year":"2018","journal-title":"J Immunol Sci"},{"key":"B30","doi-asserted-by":"publisher","first-page":"101249","DOI":"10.1016\/j.cpcardiol.2022.101249","article-title":"Research progress on the pathogenesis of aortic dissection","volume":"48","author":"Yin","year":"2023","journal-title":"Curr Probl Cardiol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"7678","DOI":"10.3390\/ijms21207678","article-title":"The role of inflammation and myeloperoxidase-related oxidative stress in the pathogenesis of genetically triggered thoracic aortic aneurysms","volume":"21","author":"Malecki","year":"2020","journal-title":"Int J Mol Sci"},{"key":"B32","doi-asserted-by":"publisher","first-page":"682","DOI":"10.3390\/antiox10050682","article-title":"Hydrogen sulfide attenuates aortic remodeling in aortic dissection associating with moderated inflammation and oxidative stress through a NO-dependent pathway","volume":"10","author":"Lu","year":"2021","journal-title":"Antioxidants (Basel)"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1410477","DOI":"10.3389\/fcvm.2024.1410477","article-title":"The role of oxidative stress in aortic dissection: a potential therapeutic target","volume":"11","author":"Xu","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.3390\/antiox12051106","article-title":"Alteration of blood oxidative stress status in patients with thoracic aortic dissection: a pilot study","volume":"12","author":"Pincemail","year":"2023","journal-title":"Antioxidants"},{"key":"B35","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1016\/j.amjmed.2019.10.031","article-title":"Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: a prospective study","volume":"133","author":"Eckart","year":"2020","journal-title":"Am J Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1007\/s00595-022-02566-9","article-title":"Preoperative hypoalbuminemia in patients undergoing cardiac surgery: a meta-analysis","volume":"53","author":"Xu","year":"2023","journal-title":"Surg Today"},{"key":"B37","article-title":"Hypovolemia and hypovolemic shock","volume-title":"StatPearls [Internet]","author":"Taghavi","year":"2025"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1539267\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T05:25:26Z","timestamp":1759123526000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1539267\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":37,"alternative-id":["10.3389\/fcvm.2025.1539267"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1539267","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]},"article-number":"1539267"}}