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
Open accessAbstract
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.
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References 30
- Authors
- Zhao, W., Ge, M., Cheng, Y., Chen, M., Zhou, Q., & Yu, W.
- Affiliations
- Nanjing Drum Tower Hospital (CN)
- Corresponding author
- Chen, Ming
- Zhou, Qing
- Yu, Wenkui
- Venue
- Frontiers in Cardiovascular Medicine
- Publisher
- Frontiers Media SA
- Published
- 2026-07-10
- Volume
- 13
- Pages
- 1817670-1817670
- ISSN
- 2297-055X (ISSN-L)
- OpenAlex
- W7167923414
- Cited by
- 0
- References
- 30
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Cardiovascular Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- postoperative acute kidney injury, type A aortic dissection, contrast-enhanced CT angiography, risk prediction model, AKI stage, renal function recovery, risk factors, ICU length of stay, risk stratification, contrast-induced nephropathy, XGBoost-SHAP, LASSO
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