Mortaligy risk prediction models for acute type A aortic dissection: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

GUO Zhiran ¹ ,  HUANG Sufang ¹ , LI Miqi ²

1. Department of Emergency, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, P.R.China;
2. Department of Nursing, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, P.R.China;

Corresponding author：

HUANG Sufang, Email: huangsufang@tjh.tjmu.edu.cn

Keywords：

Aortic dissection type A; Mortality; Prediction model; Systematic review

DOI：

10.7507/1672-2531.202108164

Video：

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Objective To systematically review mortality risk prediction models for acute type A aortic dissection (AAAD). Methods PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies of mortality risk prediction models for AAAD from inception to July 31^th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Systematic review was then performed. Results A total of 19 studies were included, of which 15 developed prediction models. The performance of prediction models varied substantially (AUC were 0.56 to 0.92). Only 6 studies reported calibration statistics, and all models had high risk of bias. Conclusions Current prediction models for mortality and prognosis of AAAD patients are suboptimal, and the performance of the models varies significantly. It is still essential to establish novel prediction models based on more comprehensive and accurate statistical methods, and to conduct internal and a large number of external validations.

Citation： GUO Zhiran, HUANG Sufang, LI Miqi. Mortaligy risk prediction models for acute type A aortic dissection: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(11): 1299-1307. doi: 10.7507/1672-2531.202108164 Copy

1.	Parve S, Ziganshin BA, Elefteriades JA. Overview of the current knowledge on etiology, natural history and treatment of aortic dissection. J Cardiovasc Surg (Torino), 2017, 58(2): 238-251.
2.	Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol, 1972, 30(3): 263-273.
3.	Ahlsson A, Wickbom A, Geirsson A, et al. Is there a weekend effect in surgery for type a dissection. Results from the nordic consortium for acute type A aortic dissection database. Ann Thorac Surg, 2019, 108(3): 770-776.
4.	Moons KG, de Groot JA, Bouwmeester W, et al. Critical appraisal and data extraction for systematic reviews of prediction modeling studies: the CHARMS checklist. PLoS Med, 2014, 11(10): e1001744.
5.	Wolff RF, Moons KGM, Riley RD, et al. PROBAST: a tool to assess the risk of bias and applicability of prediction model studies. Ann Intern Med, 2019, 170(1): 51-58.
6.	Moons KGM, Wolff RF, Riley RD, et al. PROBAST: A tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration. Ann Intern Med, 2019, 170(1): W1-W33.
7.	Tan ME, Kelder JC, Morshuis WJ, et al. Risk stratification in acute type A dissection: proposition for a new scoring system. Ann Thorac Surg, 2001, 72(6): 2065-2069.
8.	Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
9.	Centofanti P, Flocco R, Ceresa F, et al. Is surgery always mandatory for type A aortic dissection. Ann Thorac Surg, 2006, 82(5): 1658-1663.
10.	Rampoldi V, Trimarchi S, Eagle KA, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the international registry of acute aortic dissection score. Ann Thorac Surg, 2007, 83(1): 55-61.
11.	Macrina F, Puddu PE, Sciangula A, et al. Artificial neural networks versus multiple logistic regression to predict 30-day mortality after operations for type A ascending aortic dissection. Open Cardiovasc Med J, 2009, 3: 81-95.
12.	Macrina F, Puddu PE, Sciangula A, et al. Long-term mortality prediction after operations for type A ascending aortic dissection. J Cardiothorac Surg, 2010, 5: 42.
13.	Leontyev S, Légaré JF, Borger MA, et al. Creation of a scorecard to predict in-hospital death in patients undergoing operations for acute type A aortic dissection. Ann Thorac Surg, 2016, 101(5): 1700-1706.
14.	Mejàre-Berggren H, Olsson C. Validation and adjustment of the leipzig-halifax acute aortic dissection type A scorecard. Ann Thorac Surg, 2017, 104(5): 1577-1582.
15.	Ghoreishi M, Wise ES, Croal-Abrahams L, et al. A novel risk score predicts operative mortality after acute type A aortic dissection repair. Ann Thorac Surg, 2018, 106(6): 1759-1766.
16.	Yang G, Zhou Y, He H, et al. A nomogram for predicting in-hospital mortality in acute type A aortic dissection patients. J Thorac Dis, 2020, 12(3): 264-275.
17.	Kuang J, Yang J, Wang Q, et al. A preoperative mortality risk assessment model for Stanford type A acute aortic dissection. BMC Cardiovasc Disord, 2020, 20(1): 508.
18.	于鑫溢. Stanford A型主动脉夹层术后院内死亡的术前危险因素分析及预测模型构建. 郑州: 郑州大学, 2020.
19.	Czerny M, Siepe M, Beyersdorf F, et al. Prediction of mortality rate in acute type A dissection: the German registry for acute type A aortic dissection score. Eur J Cardiothorac Surg, 2020, 58(4): 700-706.
20.	Hirata K, Oda S, Suzuki R, et al. Long-term prognostic value of the combined assessment of clinical and computed tomography findings in type: An acute aortic dissection. Medicine (Baltimore), 2020, 99(45): e23008.
21.	Luo JC, Zhong J, Duan WX, et al. Early risk stratification of acute type A aortic dissection: development and validation of a predictive score. Cardiovasc Diagn Ther, 2020, 10(6): 1827-1838.
22.	Vrsalovic M, Zeljkovic I, Presecki AV, et al. C-reactive protein, not cardiac troponin T, improves risk prediction in hypertensive with type A aortic dissection. Blood, 2015, 24(4): 212-216.
23.	Yu PJ, Cassiere HA, Kohn N, et al. Utility of established risk models to predict surgical mortality in acute type-A aortic dissection. J Cardiothorac Vasc Anesth, 2016, 30(1): 39-43.
24.	Poghosyan K, Sahakyan Y, Thompson ME, et al. External validation of Leipzig-Halifax scores for aortic dissection in Armenia. Asian Cardiovasc Thorac Ann, 2021, 29(1): 10-18.
25.	Luehr M, Merkle-Storms J, Gerfer S, et al. Evaluation of the GERAADA score for prediction of 30-day mortality in patients with acute type A aortic dissection. Eur J Cardiothorac Surg, 2021, 59(5): 1109-1114.
26.	Harrell FE, Lee KL, Matchar DB, et al. Regression models for prognostic prediction: advantages, problems, and suggested solutions. Cancer Treat Rep, 1985, 69(10): 1071-1077.
27.	Tan J, Qi Y, Liu C, et al. The use of rigorous methods was strongly warranted among prognostic prediction models for obstetric care. J Clin Epidemiol, 2019, 115: 98-105.
28.	Cummings P. Missing data and multiple imputation. JAMA Pediatr, 2013, 167(7): 656-661.
29.	许汝福. Logistic回归变量筛选及回归方法选择实例分析. 中国循证医学杂志, 2016, 16(11): 1360-1364.
30.	徐欣怡, 许勤, 花红霞, 等. 基于预测模型的消化道肿瘤术后疲劳风险筛查评分量表的构建与应用. 中国全科医学, 2020, 23(14): 1819-1826,1832.
31.	郭晋. 神经网络模型在预测急性心肌梗死中的应用及模型预测能力的比较研究. 北京: 北京协和医学院, 2013.
32.	Ren Y, Huang S, Li Q, et al. Prognostic factors and prediction models for acute aortic dissection: a systematic review. BMJ Open, 2021, 11(2): e042435.

1. Parve S, Ziganshin BA, Elefteriades JA. Overview of the current knowledge on etiology, natural history and treatment of aortic dissection. J Cardiovasc Surg (Torino), 2017, 58(2): 238-251.
2. Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol, 1972, 30(3): 263-273.
3. Ahlsson A, Wickbom A, Geirsson A, et al. Is there a weekend effect in surgery for type a dissection. Results from the nordic consortium for acute type A aortic dissection database. Ann Thorac Surg, 2019, 108(3): 770-776.
4. Moons KG, de Groot JA, Bouwmeester W, et al. Critical appraisal and data extraction for systematic reviews of prediction modeling studies: the CHARMS checklist. PLoS Med, 2014, 11(10): e1001744.
5. Wolff RF, Moons KGM, Riley RD, et al. PROBAST: a tool to assess the risk of bias and applicability of prediction model studies. Ann Intern Med, 2019, 170(1): 51-58.
6. Moons KGM, Wolff RF, Riley RD, et al. PROBAST: A tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration. Ann Intern Med, 2019, 170(1): W1-W33.
7. Tan ME, Kelder JC, Morshuis WJ, et al. Risk stratification in acute type A dissection: proposition for a new scoring system. Ann Thorac Surg, 2001, 72(6): 2065-2069.
8. Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
9. Centofanti P, Flocco R, Ceresa F, et al. Is surgery always mandatory for type A aortic dissection. Ann Thorac Surg, 2006, 82(5): 1658-1663.
10. Rampoldi V, Trimarchi S, Eagle KA, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the international registry of acute aortic dissection score. Ann Thorac Surg, 2007, 83(1): 55-61.
11. Macrina F, Puddu PE, Sciangula A, et al. Artificial neural networks versus multiple logistic regression to predict 30-day mortality after operations for type A ascending aortic dissection. Open Cardiovasc Med J, 2009, 3: 81-95.
12. Macrina F, Puddu PE, Sciangula A, et al. Long-term mortality prediction after operations for type A ascending aortic dissection. J Cardiothorac Surg, 2010, 5: 42.
13. Leontyev S, Légaré JF, Borger MA, et al. Creation of a scorecard to predict in-hospital death in patients undergoing operations for acute type A aortic dissection. Ann Thorac Surg, 2016, 101(5): 1700-1706.
14. Mejàre-Berggren H, Olsson C. Validation and adjustment of the leipzig-halifax acute aortic dissection type A scorecard. Ann Thorac Surg, 2017, 104(5): 1577-1582.
15. Ghoreishi M, Wise ES, Croal-Abrahams L, et al. A novel risk score predicts operative mortality after acute type A aortic dissection repair. Ann Thorac Surg, 2018, 106(6): 1759-1766.
16. Yang G, Zhou Y, He H, et al. A nomogram for predicting in-hospital mortality in acute type A aortic dissection patients. J Thorac Dis, 2020, 12(3): 264-275.
17. Kuang J, Yang J, Wang Q, et al. A preoperative mortality risk assessment model for Stanford type A acute aortic dissection. BMC Cardiovasc Disord, 2020, 20(1): 508.
18. 于鑫溢. Stanford A型主动脉夹层术后院内死亡的术前危险因素分析及预测模型构建. 郑州: 郑州大学, 2020.
19. Czerny M, Siepe M, Beyersdorf F, et al. Prediction of mortality rate in acute type A dissection: the German registry for acute type A aortic dissection score. Eur J Cardiothorac Surg, 2020, 58(4): 700-706.
20. Hirata K, Oda S, Suzuki R, et al. Long-term prognostic value of the combined assessment of clinical and computed tomography findings in type: An acute aortic dissection. Medicine (Baltimore), 2020, 99(45): e23008.
21. Luo JC, Zhong J, Duan WX, et al. Early risk stratification of acute type A aortic dissection: development and validation of a predictive score. Cardiovasc Diagn Ther, 2020, 10(6): 1827-1838.
22. Vrsalovic M, Zeljkovic I, Presecki AV, et al. C-reactive protein, not cardiac troponin T, improves risk prediction in hypertensive with type A aortic dissection. Blood, 2015, 24(4): 212-216.
23. Yu PJ, Cassiere HA, Kohn N, et al. Utility of established risk models to predict surgical mortality in acute type-A aortic dissection. J Cardiothorac Vasc Anesth, 2016, 30(1): 39-43.
24. Poghosyan K, Sahakyan Y, Thompson ME, et al. External validation of Leipzig-Halifax scores for aortic dissection in Armenia. Asian Cardiovasc Thorac Ann, 2021, 29(1): 10-18.
25. Luehr M, Merkle-Storms J, Gerfer S, et al. Evaluation of the GERAADA score for prediction of 30-day mortality in patients with acute type A aortic dissection. Eur J Cardiothorac Surg, 2021, 59(5): 1109-1114.
26. Harrell FE, Lee KL, Matchar DB, et al. Regression models for prognostic prediction: advantages, problems, and suggested solutions. Cancer Treat Rep, 1985, 69(10): 1071-1077.
27. Tan J, Qi Y, Liu C, et al. The use of rigorous methods was strongly warranted among prognostic prediction models for obstetric care. J Clin Epidemiol, 2019, 115: 98-105.
28. Cummings P. Missing data and multiple imputation. JAMA Pediatr, 2013, 167(7): 656-661.
29. 许汝福. Logistic回归变量筛选及回归方法选择实例分析. 中国循证医学杂志, 2016, 16(11): 1360-1364.
30. 徐欣怡, 许勤, 花红霞, 等. 基于预测模型的消化道肿瘤术后疲劳风险筛查评分量表的构建与应用. 中国全科医学, 2020, 23(14): 1819-1826,1832.
31. 郭晋. 神经网络模型在预测急性心肌梗死中的应用及模型预测能力的比较研究. 北京: 北京协和医学院, 2013.
32. Ren Y, Huang S, Li Q, et al. Prognostic factors and prediction models for acute aortic dissection: a systematic review. BMJ Open, 2021, 11(2): e042435.

Chinese Journal of Evidence-Based Medicine

Mortaligy risk prediction models for acute type A aortic dissection: a systematic review

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