ArticleFrontiers in cardiovascular medicine2026
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.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 ( 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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