Predictors and dynamic online nomogram for postoperative delayed hyponatremia after endoscopic transsphenoidal surgery for pituitary adenomas: a single-center, retrospective, observational cohort study with external validation

Chinese Neurosurgical Journal

Research

Yuxiu Liu¹  Feng Yuan²  Chaonan Du²  Junhao Zhu²  An Zhang³  Jin Yang³  Chao Tang³  Zixiang Cong⁴  Xiangming Cai⁵  Chiyuan Ma⁶  Yiliyaer Aili⁷  Yuanming Geng⁷  Zhiyuan Liu⁸  Peng Zhao⁸  Xinrui Zeng⁹ 

[1] Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China;Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China;Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China;Department of Neurosurgery, Jinling Hospital, Nanjing, China;Department of Neurosurgery, Jinling Hospital, Nanjing, China;Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China;Department of Neurosurgery, Jinling Hospital, Nanjing, China;School of Medicine, Southeast University, Nanjing, China;Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands;Department of Neurosurgery, Jinling Hospital, Nanjing, China;School of Medicine, Southeast University, Nanjing, China;Department of Neurosurgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China;Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China;Department of Neurosurgery, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, China;Department of Neurosurgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China;Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China;School of Medicine, Southeast University, Nanjing, China;

关键词: Endoscopic transsphenoidal surgery;    Nomogram;    Pituitary adenomas;    Postoperative delayed hyponatremia;    Predictors;   

DOI  :  10.1186/s41016-023-00334-3

 received in 2023-02-13, accepted in 2023-06-15,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPostoperative delayed hyponatremia (PDH) is a major cause of readmission after endoscopic transsphenoidal surgery (eTSS) for pituitary adenomas (PAs). However, the risk factors associated with PDH have not been well established, and the development of a dynamic online nomogram for predicting PDH is yet to be realized. We aimed to investigate the predictive factors for PDH and construct a dynamic online nomogram to aid in its prediction.MethodsWe analyzed the data of 226 consecutive patients who underwent eTSS for PAs at the Department of Neurosurgery in Jinling Hospital between January 2018 and October 2020. An additional 97 external patients were included for external validation. PDH was defined as a serum sodium level below 137 mmol/L, occurring on the third postoperative day (POD) or later.ResultsHyponatremia on POD 1–2 (OR = 2.64, P = 0.033), prothrombin time (PT) (OR = 1.78, P = 0.008), and percentage of monocytes (OR = 1.22, P = 0.047) were identified as predictive factors for PDH via multivariable logistic regression analysis. Based on these predictors, a nomogram was constructed with great discrimination in internal validation (adjusted AUC: 0.613–0.688) and external validation (AUC: 0.594–0.617). Furthermore, the nomogram demonstrated good performance in calibration plot, Brier Score, and decision curve analysis. Subgroup analysis revealed robust predictive performance in patients with various clinical subtypes and mild to moderate PDH.ConclusionsPreoperative PT and the percentage of monocytes were, for the first time, identified as predictive factors for PDH. The dynamic nomogram proved to be a valuable tool for predicting PDH after eTSS for PAs and demonstrated good generalizability. Patients could benefit from early identification of PDH and optimized treatment decisions.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 2

Fig. 1