{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T22:54:53Z","timestamp":1788908093445,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"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. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This multicenter study developed and internally validated a biomarker-enhanced risk prediction nomogram integrating hemodynamic parameters and novel urinary biomarkers to stratify postoperative acute kidney injury (AKI) risks in patients undergoing emergency surgical repair for acute Stanford Type A aortic dissection (ATAAD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort of 1,277 patients from the China Aortic Dissection Alliance (CADA) registry was chronologically split into derivation (70%, <jats:italic>n<\/jats:italic>\u202f=\u202f894) and validation (30%, <jats:italic>n<\/jats:italic>\u202f=\u202f383) sets. LASSO regression with 10-fold cross-validation (\u03bb1SE criterion) was applied to identify non-redundant predictors from 34 candidate variables (e.g., cardiac dysfunction [LVEF &amp;lt;50% or INTERMACS 1\u20133]) and elevated urinary biomarkers. Multivariable logistic regression refined these predictors to establish independent risk factors for the final nomogram. Model performance was evaluated using the concordance index (C-index), area under the receiver operating characteristic curve (AUC-ROC), calibration plots (Brier score and Hosmer-Lemeshow test), and decision curve analysis (DCA) to quantify clinical utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multivariable analysis identified seven independent predictors of postoperative AKI: preexisting cardiac dysfunction (adjusted odds ratio [aOR]\u202f=\u202f2.17; 95% CI: 1.68\u20133.56), microvascular complications of diabetes (aOR\u202f=\u202f3.26; 2.71\u20134.34), baseline renal impairment (aOR\u202f=\u202f1.72; 1.36\u20133.29), blood urea nitrogen (BUN)\u202f\u2265\u202f20\u202fmg\/dL (aOR\u202f=\u202f2.19; 1.57\u20133.64), glomerular filtration rate (GFR)\u202f&amp;lt;\u202f90\u202fmL\/min\/1.73\u202fm<jats:sup>2<\/jats:sup> (aOR\u202f=\u202f1.47; 1.02\u20132.13), serum creatinine &amp;gt;1.3\u202fmg\/dL (aOR\u202f=\u202f3.28; 2.58\u20133.75), and peripheral vasculopathy (aOR\u202f=\u202f1.78; 1.12\u20132.32). The model demonstrated strong discrimination (training AUC-ROC: 0.830 [0.802\u20130.858]; internal validation AUC-ROC: 0.786 [0.737\u20130.834]), calibration (Brier scores: 0.138 training, 0.141 validation), and clinical utility (net reclassification improvement [NRI]\u202f=\u202f0.21, <jats:italic>p<\/jats:italic>\u202f=\u202f0.001), with optimal decision thresholds at 40\u201360% probability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The nomogram demonstrates superior preoperative discriminative accuracy in AKI following ATAAD repair surgery. External validation via the VASCUNET registry is planned to confirm generalizability.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1562956","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T05:30:24Z","timestamp":1747287024000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["AKI prediction model in acute aortic dissection surgery: nomogram development and validation"],"prefix":"10.3389","volume":"12","author":[{"given":"Rui","family":"Du","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lai","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhitao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Zuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"117232","DOI":"10.1016\/j.cca.2023.117232","article-title":"Association between preoperative serum myoglobin and acute kidney injury after Stanford type A aortic dissection surgery","volume":"541","author":"Chen","year":"2023","journal-title":"Clin Chim Acta"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"734","DOI":"10.11909\/j.issn.1671-5411.2022.10.003","article-title":"Development and validation of a nomogram for postoperative severe acute kidney injury in acute type A aortic dissection","volume":"19","author":"Luo","year":"2022","journal-title":"J Geriatr Cardiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s13019-022-01813-x","article-title":"The association between lymphocyte-monocyte ratio and postoperative acute kidney injury in patients with acute type A aortic dissection","volume":"17","author":"Chen","year":"2022","journal-title":"J Cardiothorac Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"658-+","DOI":"10.21037\/jtd-23-38","article-title":"The association of coagulation indicators with in-hospital acute kidney injury and malignant events of patients with acute aortic dissection: a retrospective cohort study","volume":"15","author":"Jiang","year":"2023","journal-title":"J Thorac Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2021\/2274430","article-title":"Association between prognostic nutritional index and contrast-associated acute kidney injury in patients complicated with chronic kidney disease and coronary artery disease","volume":"2021","author":"Dong","year":"2021","journal-title":"J Interv Cardiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1629","DOI":"10.1001\/jama.2020.18618","article-title":"Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on Dialysis filter life span and mortality among critically ill patients with acute kidney injury a randomized clinical trial","volume":"324","author":"Zarbock","year":"2020","journal-title":"J Am Med Assoc"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2856","DOI":"10.1007\/s00330-017-5247-4","article-title":"Post-contrast acute kidney injury. 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