Association between inflammatory markers and continuous renal replacement therapy after acute type A aortic dissection surgery

Postoperative continuous renal replacement therapy (CRRT) is a life-threatening complication following acute type A aortic dissection (ATAAD) surgery and is closely associated with the inflammatory response. However, no predictive models for CRRT after ATAAD surgery have been reported. This study aims to explore the association between blood count-derived inflammatory markers and the occurrence of CRRT and to develop a predictive model for its risk. A total of 1310 patients who underwent ATAAD surgery were retrospectively analyzed and randomly divided into a training cohort (70%) and a validation cohort (30%). Multivariate logistic regression was used to identify independent risk factors for CRRT, which were incorporated into a nomogram. The model’s predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC), and its calibration was assessed in both cohorts. CRRT occurred in 19.2% (n=251) of patients. The overall hospital mortality was 12.1% (n=159), while the mortality rate among CRRT patients reached 31.9%. Independent predictors for CRRT included older age, elevated inflammatory markers (white blood cell count, C-reactive protein), elevated creatinine and fibrinogen levels, prolonged cardiopulmonary bypass duration, and extended mechanical ventilation. The resulting nomogram achieved an AUC of 0.886 in the validation cohort and demonstrated good calibration. Blood-derived inflammatory markers are independently associated with the risk of CRRT following ATAAD surgery. The developed nomogram, based on these markers and clinical variables, provides strong discriminatory and predictive capability. This model may improve perioperative risk stratification and help guide clinical decision-making to reduce in-hospital adverse outcomes.