The purposes of this study were to develop and validate a nomogram for predicting postoperative transient neurological dysfunctions (TND) in patients with acute type A aortic dissection (AAAD) who underwent modified triple-branched stent graft implantation. This retrospective study developed a nomogram-based model in a consecutive cohort of 146 patients. Patient characteristics, preoperative clinical indices, and operative data were analyzed. Univariate and multivariable analyses were applied to identify the most useful predictive variables for constructing the nomogram. Discrimination and the calibration of the model was evaluated through the receiver operating characteristic curve (ROC), the Hosmer–Lemeshow goodness-of-fit test and the decision curve analysis (DCA). At the same time, to identify and compare long-term cumulative survival rate, Kaplan-Meier survival curve was plotted. The incidence rate of postoperative TND observed in our cohort were 40.9%. Supra-aortic dissection with or without thrombosis, creatinine >115 μmol and albumin <39.7 g/L, selective antegrade cerebral perfusion (SACP) time >7 min and total operation time >303 min, were confirmed as independent predictors that enhanced the likelihood of TND. Internal validation showed good discrimination of the model with under the ROC curve (AUC) of 0.818 and good calibration (Hosmer–Lemeshow test, p > .05). DCA revealed that the nomogram was clinically useful. In the long-term survival there was no significant difference between patients with or without TND history. The results showed the predict model based on readily available predictors has sufficient validity to identify TND risk in this population, that maybe useful for clinical decision-making.

中文翻译：

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基于列线图的模型可预测接受急性 A 型主动脉夹层手术的患者术后短暂神经功能障碍

本研究的目的是开发并验证列线图，用于预测接受改良三分支覆膜支架植入的急性 A 型主动脉夹层 (AAAD) 患者术后短暂性神经功能障碍 (TND)。这项回顾性研究在 146 名患者的连续队列中开发了基于列线图的模型。分析患者特征、术前临床指标和手术数据。应用单变量和多变量分析来确定构建列线图最有用的预测变量。通过接受者操作特征曲线（ROC）、Hosmer-Lemeshow拟合优度检验和决策曲线分析（DCA）来评估模型的区分度和校准。同时，为了确定和比较长期累积生存率，绘制了Kaplan-Meier生存曲线。在我们的队列中观察到的术后 TND 发生率为 40.9%。主动脉上夹层伴或不伴血栓、肌酐 >115 μmol 和白蛋白 <39.7 g/L、选择性顺行脑灌注 (SACP) 时间 >7 分钟和总手术时间 >303 分钟，被证实为独立预测因素，可增强TND。内部验证显示模型具有良好的区分度，ROC 曲线下 (AUC) 为 0.818，且校准良好（Hosmer-Lemeshow 检验，p  > .05）。DCA 表明列线图在临床上是有用的。在长期生存方面，有或没有 TND 病史的患者之间没有显着差异。结果表明，基于现成预测因子的预测模型具有足够的有效性来识别该人群的 TND 风险，这可能对临床决策有用。