The Application Of CTn-I Combined With Random Forest In Predicting The Rupture Of Acute Type A Aortic Dissection

Objective:This study analyzes the application value of cTn-I combined with RF model to predict the rupture of patients with ATAAD,and aims to screen out patients with ATAAD with higher risk of rupture as early as possible.The surgical treatment will be given in advance to reduce the risk of death of AT AAD patients and improve the survival rate of them.Methods:In this study,a retrospective analysis method was used to collect general Data and average value of cTn-I from the patients with ATAAD,examined by CTA and TTE after admission who visited the emergency department of Yan ’an Hospital Affiliated to Kunming Medical University,from September 2018 to December 2020.All the patients were divided into ruptured group and un-ruptured group according to whether they dead of aortic dissection rupture after admission to surgery(2 weeks after diagnosis).The general conditions and related factors of patients in the two groups were compared to see if there were any differences.Logistic regression analysis was conducted on the factors with significant differences to explore the correlation between the above risk factors and the rupture of ATAAD.RF model was used to predict the outcome of ATAAD patients,and the validity index of the prediction results of RF model was calculated.The correlation between the RF model,the cTn-I value and the rupture of ATAAD was analyzed.The ROC of RF model and cTn-I value were drawn,and the cut-off value of cTn-I for predicting the rupture of ATAAD was calculated by using the maximum Youden Index.According to the cut-off value of cTn-I,the validity index of predicting ATAAD rupture by cTn-I value was calculated.The ROC of RF model,cTn-I value and the combined of the two were plotted,the same as the AUC.Kappa consistency test was used to test and analyze the prediction results of cTn-I combined with RF model,and the validity index of the combined prediction of ATAAD fracture was obtained.Results:A total of 153 ATAAD patients were included in this study,including 44 patients with rupture,with an average age of 57.22±11.32 years.There were 109 survival patients,with an average age of 53.52± 12.75 years.There were significant differences between the two groups in gender,syncope,WBC>15×10^9/L,pericardial hemopericardium,and periaortic hematoma(P<0.05),while there were significant differences in age,hypertension,numbness/pain in lower limbs,and De Bakey Type I,brachiocephalic trunk involvement,acute liver function injury,pleural effusion,blood pressure at admission>160mmHg,renal artery involvement,AHI,BMI(P>0.05).Logical regression analysis of the above factors with significant differences showed that pericardial hematoma and periaortic hematoma were significantly associated with rupture of ATAAD,and the risk of rupture in ATAAD patients with pericardial hematoma increased by 0.131 times.the risk of rupture in ATAAD patients with pericardial hematoma increased by 0.227.2.The RF prediction results were positively correlated with rupture in ATAAD patients,with sensitivity of 68.2%,specificity of 83.4%,positive predictive value of 62.5%,negative predictive value of 86.7%,positive likelihood ratio of 4.1,negative likelihood ratio of 0.38,Youden index of 51.6%,and AUC of 0.758.3.cTn-I value was positively correlated with rupture in ATAAD patients,with sensitivity of 72.7%,specificity of 72.5%,maximum Youden index of 45.2%,positive predictive value of 51.6%,negative predictive value of 86.8%,positive likelihood ratio of 2.64,negative likelihood ratio of 0.38,AUC of 0.716,respectively.The critical value of cTn-I is 0.075ng/mL according to the maximum Youden index.4.The AUC of ATAAD rupture predicted by cTn-I combined with RF model is 0.844;The sensitivity was 72.7%,the specificity was 86.2%,and the maximum approximate index was 58.9%.The AUC was higher than that of the two treatments alone,and the difference was statistically significant.5.Kappa consistency test was carried out on the prediction of ATAAD rupture by cTn-I combined with RF model,and the Kappa value was 0.4655,suggesting that the prediction of ATAAD rupture by it had a good consistency.Conclusion(s):1.There was a positive correlation between cTn-I value and rupture in ATAAD patients,and the cut-off value of cTn-I predicted rupture in ATAAD was 0.075ng/ml.2.cTn-I combined with random forest model has a good consistency in predicting ATAAD rupture,and the combined prediction effect of the two models is better than that of single application.