Cai Xiangming, Zhang An, Zhao Peng, Liu Zhiyuan, Aili Yiliyaer, Zeng Xinrui, Geng Yuanming, Du Chaonan, Yuan Feng, Zhu Junhao, Yang Jin, Tang Chao, Cong Zixiang, Liu Yuxiu, Ma Chiyuan
Department of Neurosurgery, Jinling Hospital, Nanjing, China.
School of Medicine, Southeast University, Nanjing, China.
Chin Neurosurg J. 2023 Aug 1;9(1):19. doi: 10.1186/s41016-023-00334-3.
Postoperative 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.
We 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.
Hyponatremia 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.
Preoperative 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.
术后迟发性低钠血症（PDH）是垂体腺瘤（PA）经鼻内镜经蝶窦手术（eTSS）后再入院的主要原因。然而，与PDH相关的危险因素尚未完全明确，且尚未实现用于预测PDH的动态在线列线图。我们旨在研究PDH的预测因素，并构建动态在线列线图以辅助其预测。
我们分析了2018年1月至2020年10月在金陵医院神经外科连续接受eTSS治疗PA的226例患者的数据。另外纳入97例外部患者进行外部验证。PDH定义为术后第三天（POD）或之后血清钠水平低于137 mmol/L。
通过多变量逻辑回归分析，术后第1 - 2天低钠血症（OR = 2.64，P = 0.033）、凝血酶原时间（PT）（OR = 1.78，P = 0.008）和单核细胞百分比（OR = 1.22，P = 0.047）被确定为PDH的预测因素。基于这些预测因素，构建了一个列线图，其在内部验证（校正AUC：0.613 - 0.688）和外部验证（AUC：0.594 - 0.617）中具有良好的区分度。此外，列线图在校准图、Brier评分和决策曲线分析中表现良好。亚组分析显示在各种临床亚型和轻至中度PDH患者中具有强大的预测性能。
术前PT和单核细胞百分比首次被确定为PDH的预测因素。动态列线图被证明是预测PA患者eTSS术后PDH的有价值工具，并具有良好的通用性。患者可从早期识别PDH和优化治疗决策中受益。
