Prognosis of acute gastrointestinal injury in patients early after acute type A aortic dissection repair and the Nomogram prediction model development_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Xiaofang , HU Yuan , DANG Guoqin , ZHOU Wenjun , LI Yuanmin ,  MENG Wenbo

The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;

Corresponding author：

MENG Wenbo, Email: mengwb@lzu.edu.cn

Keywords：

Acute type A aortic dissection; gastrointestinal injury; disease prediction model; Nomogram

DOI：

10.7507/1007-4848.202202016

Video：

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Objective To analyze the risk factors and prognosis of acute gastrointestinal injury (AGI) early after acute type A aortic dissection (ATAAD) repair, and develop the Nomogram prediction model of AGI. Methods The patients who underwent ATAAD cardiopulmonary bypass surgery in our hospital from 2016 to 2021 were collected and divided into an AGI group and a non-AGI group. The clinical data of the two groups were compared. A Nomogram prediction model was established by using R language. Results A total of 188 patients were enrolled, including 166 males and 22 females, aged 22-70 (49.70±9.96) years. Through multivariate logistic regression analysis, the aortic dissection (AD) risk score, poor perfusion of superior mesenteric artery (SMA), duration of aortic occlusion and intraoperative infusion of red blood cells were the predictors for AGI (P<0.05). There were statistical differences in the ventilator-assisted duration, ICU stay time, liver dysfunction, renal insufficiency, parenteral nutrition, nosocomial infection and death within 30 days after the operation between the two groups (P<0.05). The Nomogram prediction model was established by using the prediction factors, and the C index was 0.888. Through internal verification, the C index was 0.848. The receiver operating characteristic curve was used to evaluate the discrimination of the model, and the area under the curve was 0.888. Conclusion The AD risk score after ATAAD, poor perfusion of SMA, duration of aortic occlusion and intraoperative infusion of red blood cells are independent predictors for AGI. The Nomogram model has good prediction ability.

Citation： YANG Xiaofang, HU Yuan, DANG Guoqin, ZHOU Wenjun, LI Yuanmin, MENG Wenbo. Prognosis of acute gastrointestinal injury in patients early after acute type A aortic dissection repair and the Nomogram prediction model development. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(11): 1598-1603. doi: 10.7507/1007-4848.202202016 Copy

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2.	Chor CYT, Mahmood S, Khan IH, et al. Gastrointestinal complications following cardiac surgery. Asian Cardiovasc Thorac Ann, 2020, 28(9): 621-632.
3.	Frankel WC, Green SY, Amarasekara HS, et al. Early gastrointestinal complications after open thoracoabdominal aortic aneurysm repair. Ann Thorac Surg, 2021, 112(3): 717-724.
4.	Seilitz J, Edström M, Sköldberg M, et al. Early onset of postoperative gastrointestinal dysfunction is associated with unfavorable outcome in cardiac surgery: A prospective observational study. J Intensive Care Med, 2021, 36(11): 1264-1271.
5.	Sun LZ, Liu NN, Qian C, et al. The application of modified classification of the aortic dissection. Chin J Surg, 2005, 43(18): 1171-1176.
6.	Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A. Ann Thorac Surg, 2002, 73(3): 714-718.
7.	陈鑫, 黄福华, 徐明, 等. 孙氏手术治疗急性StanfordA型主动脉夹层. 中华胸心血管外科杂志, 2012, 28(6): 333-335, 339.
8.	Arsalan M, Squiers JJ, Herbert MA, et al. Comparison of outcomes of operative therapy for acute type A aortic dissections provided at high-volume versus low-volume medical centers in North Texas. Am J Cardiol, 2017, 119(2): 323-327.
9.	Goldstone AB, Chiu P, Baiocchi M, et al. Interfacility transfer of medicare beneficiaries with acute type A aortic dissection and regionalization of care in the United States. Circulation, 2019, 140(15): 1239-1250.
10.	张辉. 149例StanfordA型主动脉夹层患者术后死亡相关危险因素分析. 河北医科大学, 2019.
11.	Bekkers JA, Raap GB, Takkenberg JJ, et al. Acute type A aortic dissection: Long-term results and reoperations. Eur J Cardiothorac Surg, 2013, 43(2): 389-396.
12.	Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest, 2002, 122(1): 311-328.
13.	Chaudhry R, Zaki J, Wegner R, et al. Gastrointestinal complications after cardiac surgery: A nationwide population-based analysis of morbidity and mortality predictors. J Cardiothorac Vasc Anesth, 2017, 31(4): 1268-1274.
14.	Rodriguez R, Robich MP, Plate JF, et al. Gastrointestinal complications following cardiac surgery: A comprehensive review. J Card Surg, 2010, 25(2): 188-197.
15.	Sever K, Ozbek C, Goktas B, et al. Gastrointestinal complications after open heart surgery: Incidence and determinants of risk factors. Angiology, 2014, 65(5): 425-429.
16.	Allen SJ. Gastrointestinal complications and cardiac surgery. J Extra Corpor Technol, 2014, 46(2): 142-149.
17.	D'Ancona G, Baillot R, Poirier B, et al. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart Inst J, 2003, 30(4): 280-285.
18.	Marsoner K, Voetsch A, Lierzer C, et al. Gastrointestinal complications following on-pump cardiac surgery—A propensity matched analysis. PLoS One, 2019, 14(6): e0217874.
19.	Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann Surg, 2007, 246(2): 323-329.
20.	Movahedi N, Karimi A, Ahmadi H, et al. Laparatomy due to gastrointestinal complications after open heart surgery. J Cardiovasc Surg, 2011, 52(1): 111-116.
21.	Guler M, Yamak B, Erdogan M, et al. Risk factors for gastrointestinal complications in patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth, 2011, 25(4): 637-641.
22.	Marik PE, Flemmer M. Narrative review: The management of acute decompensated heart failure. J Intensive Care Med, 2012, 27(6): 343-353.
23.	Perugini RA, Orr RK, Porter D, et al. Gastrointestinal complications following cardiac surgery. An analysis of 1477 cardiac surgery patients. Arch Surg, 1997, 132(4): 352-357.
24.	Haywood N, Mehaffey JH, Hawkins RB, et al. Gastrointestinal complications after cardiac surgery: Highly morbid but improving over time. J Surg Res, 2020, 254: 306-313.
25.	Hu B, Sun R, Wu A, et al. Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: A multicenter, prospective, observational study. Crit Care, 2017, 21(1): 188.
26.	Zhang D, Li N, Dong L, et al. Evaluation of clinical application of ESICM acute gastrointestinal injury grading system: A single-center observational study. Chin Med J. 2014, 127(10): 1833-1836.
27.	Zou L, Song X, Hong L, et al. Intestinal fatty acid-binding protein as a predictor of prognosis in postoperative cardiac surgery patients. Medicine (Baltimore), 2018, 97(33): e11782.
28.	Wei L, Champman S, Li X, et al. Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: A cross-sectional study in China. BMJ Open, 2017, 7(10): e017293.

1. Zheng S, Shao S, Qiao Z, et al. Clinical parameters and gut microbiome changes before and after surgery in thoracic aortic dissection in patients with gastrointestinal complications. Sci Rep, 2017, 7(1): 15228.
2. Chor CYT, Mahmood S, Khan IH, et al. Gastrointestinal complications following cardiac surgery. Asian Cardiovasc Thorac Ann, 2020, 28(9): 621-632.
3. Frankel WC, Green SY, Amarasekara HS, et al. Early gastrointestinal complications after open thoracoabdominal aortic aneurysm repair. Ann Thorac Surg, 2021, 112(3): 717-724.
4. Seilitz J, Edström M, Sköldberg M, et al. Early onset of postoperative gastrointestinal dysfunction is associated with unfavorable outcome in cardiac surgery: A prospective observational study. J Intensive Care Med, 2021, 36(11): 1264-1271.
5. Sun LZ, Liu NN, Qian C, et al. The application of modified classification of the aortic dissection. Chin J Surg, 2005, 43(18): 1171-1176.
6. Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A. Ann Thorac Surg, 2002, 73(3): 714-718.
7. 陈鑫, 黄福华, 徐明, 等. 孙氏手术治疗急性StanfordA型主动脉夹层. 中华胸心血管外科杂志, 2012, 28(6): 333-335, 339.
8. Arsalan M, Squiers JJ, Herbert MA, et al. Comparison of outcomes of operative therapy for acute type A aortic dissections provided at high-volume versus low-volume medical centers in North Texas. Am J Cardiol, 2017, 119(2): 323-327.
9. Goldstone AB, Chiu P, Baiocchi M, et al. Interfacility transfer of medicare beneficiaries with acute type A aortic dissection and regionalization of care in the United States. Circulation, 2019, 140(15): 1239-1250.
10. 张辉. 149例StanfordA型主动脉夹层患者术后死亡相关危险因素分析. 河北医科大学, 2019.
11. Bekkers JA, Raap GB, Takkenberg JJ, et al. Acute type A aortic dissection: Long-term results and reoperations. Eur J Cardiothorac Surg, 2013, 43(2): 389-396.
12. Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest, 2002, 122(1): 311-328.
13. Chaudhry R, Zaki J, Wegner R, et al. Gastrointestinal complications after cardiac surgery: A nationwide population-based analysis of morbidity and mortality predictors. J Cardiothorac Vasc Anesth, 2017, 31(4): 1268-1274.
14. Rodriguez R, Robich MP, Plate JF, et al. Gastrointestinal complications following cardiac surgery: A comprehensive review. J Card Surg, 2010, 25(2): 188-197.
15. Sever K, Ozbek C, Goktas B, et al. Gastrointestinal complications after open heart surgery: Incidence and determinants of risk factors. Angiology, 2014, 65(5): 425-429.
16. Allen SJ. Gastrointestinal complications and cardiac surgery. J Extra Corpor Technol, 2014, 46(2): 142-149.
17. D'Ancona G, Baillot R, Poirier B, et al. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart Inst J, 2003, 30(4): 280-285.
18. Marsoner K, Voetsch A, Lierzer C, et al. Gastrointestinal complications following on-pump cardiac surgery—A propensity matched analysis. PLoS One, 2019, 14(6): e0217874.
19. Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann Surg, 2007, 246(2): 323-329.
20. Movahedi N, Karimi A, Ahmadi H, et al. Laparatomy due to gastrointestinal complications after open heart surgery. J Cardiovasc Surg, 2011, 52(1): 111-116.
21. Guler M, Yamak B, Erdogan M, et al. Risk factors for gastrointestinal complications in patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth, 2011, 25(4): 637-641.
22. Marik PE, Flemmer M. Narrative review: The management of acute decompensated heart failure. J Intensive Care Med, 2012, 27(6): 343-353.
23. Perugini RA, Orr RK, Porter D, et al. Gastrointestinal complications following cardiac surgery. An analysis of 1477 cardiac surgery patients. Arch Surg, 1997, 132(4): 352-357.
24. Haywood N, Mehaffey JH, Hawkins RB, et al. Gastrointestinal complications after cardiac surgery: Highly morbid but improving over time. J Surg Res, 2020, 254: 306-313.
25. Hu B, Sun R, Wu A, et al. Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: A multicenter, prospective, observational study. Crit Care, 2017, 21(1): 188.
26. Zhang D, Li N, Dong L, et al. Evaluation of clinical application of ESICM acute gastrointestinal injury grading system: A single-center observational study. Chin Med J. 2014, 127(10): 1833-1836.
27. Zou L, Song X, Hong L, et al. Intestinal fatty acid-binding protein as a predictor of prognosis in postoperative cardiac surgery patients. Medicine (Baltimore), 2018, 97(33): e11782.
28. Wei L, Champman S, Li X, et al. Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: A cross-sectional study in China. BMJ Open, 2017, 7(10): e017293.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognosis of acute gastrointestinal injury in patients early after acute type A aortic dissection repair and the Nomogram prediction model development

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