{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T12:14:24Z","timestamp":1783685664442,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"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>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study enrolled 604 PO-AKI patients (2014\u20132024, Nanjing Drum Tower Hospital) who underwent \u22651 postoperative contrast-enhanced CTA. PC-AKI was diagnosed per 2018 ESUR guidelines (sCr elevation \u226526.5 \u03bcmol\/L or \u22651.5 times baseline within 48\u201372\u2005h, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2009=\u20093.144, 95% CI: 1.41\u20137.06) and unrecovered PO-AKI before first CTA (OR\u2009=\u200925.212, 95% CI: 12.57\u201353.49). The model exhibited good discrimination (AUC=0.848, 95% CI: 0.78\u20130.91) and calibration (Brier=0.057). PC-AKI was independently associated with prolonged ICU stay (RR\u2009=\u20091.521, 95% CI: 1.19\u20131.97) and incomplete renal recovery at discharge (OR\u2009=\u20092.554, 95% CI: 1.30\u20134.86), but not with 30-day mortality (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.606).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1817670","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:19:28Z","timestamp":1783682368000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"13","author":[{"given":"Weiwei","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YongQing","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenkui","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2845","DOI":"10.1007\/s00330-017-5246-5","article-title":"Post-contrast acute kidney injury - 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