Abstract：
BACKGROUND: To identify high-risk patients for delayed postoperative hyponatremia (DPH) early, we constructed a simple and effective scoring system.
METHODS: We retrospectively analyzed 141 consecutive patients who underwent endoscopic transsphenoidal surgery from January 2019 to December 2022. Patients were divided into DPH group and nondelayed postoperative hyponatremia group based on whether hyponatremia occurred after the third postoperative day. Multivariable logistic regression analysis was conducted to determine the predictive factors of DPH, and a simple scoring system was constructed based on these predictors.
RESULTS: Among 141 patients, 36 (25.5%) developed DPH. Multivariable logistic regression analysis showed that age ≥48 years (odds ratio [OR], 3.74; 95% confidence interval [CI], 1.14-12.21; P = 0.029), Knosp grade ≥3 (OR, 5.17; 95% CI, 1.20-22.27; P = 0.027), postoperative hypokalemia within three days (OR, 3.13; 95% CI, 1.05-9.33; P = 0.040), a difference in blood sodium levels between the first and second day after surgery ≥1 mEq/L (OR, 3.65; 95% CI, 1.05-12.77; P = 0.043), and postoperative diabetes insipidus (OR, 3.57; 95% CI, 1.16-10.96; P = 0.026) were independent predictors of DPH.
CONCLUSIONS: This scoring system for predicting DPH has an area under the receiver operating characteristic curve of 0.856 (95% CI, 0.787-0.925), indicating moderate to good predictive value for DPH in our cohort, but further prospective external validation is needed.
METHODS: We retrospectively analyzed 141 consecutive patients who underwent endoscopic transsphenoidal surgery from January 2019 to December 2022. Patients were divided into DPH group and nondelayed postoperative hyponatremia group based on whether hyponatremia occurred after the third postoperative day. Multivariable logistic regression analysis was conducted to determine the predictive factors of DPH, and a simple scoring system was constructed based on these predictors.
RESULTS: Among 141 patients, 36 (25.5%) developed DPH. Multivariable logistic regression analysis showed that age ≥48 years (odds ratio [OR], 3.74; 95% confidence interval [CI], 1.14-12.21; P = 0.029), Knosp grade ≥3 (OR, 5.17; 95% CI, 1.20-22.27; P = 0.027), postoperative hypokalemia within three days (OR, 3.13; 95% CI, 1.05-9.33; P = 0.040), a difference in blood sodium levels between the first and second day after surgery ≥1 mEq/L (OR, 3.65; 95% CI, 1.05-12.77; P = 0.043), and postoperative diabetes insipidus (OR, 3.57; 95% CI, 1.16-10.96; P = 0.026) were independent predictors of DPH.
CONCLUSIONS: This scoring system for predicting DPH has an area under the receiver operating characteristic curve of 0.856 (95% CI, 0.787-0.925), indicating moderate to good predictive value for DPH in our cohort, but further prospective external validation is needed.
摘要：
背景：为了尽早识别术后迟发性低钠血症（DPH）的高危患者，我们构建了一个简单有效的评分系统。
方法：我们回顾性分析了2019年1月至2022年12月接受内镜经蝶入路手术（TSS）的141例连续患者。根据术后第三天是否发生低钠血症将患者分为DPH组和非DPH（NDPH）组。采用多因素logistic回归分析确定DPH的预测因素,并基于这些预测因子构建了一个简单的评分系统。
结果：在141名患者中，36（25.5%）发展为DPH。多变量logistic回归分析显示年龄≥48岁(OR，3.74；95CI，1.14-12.21；P=0.029），Knosp等级≥3(OR,5.17；95CI，1.20-22.27；P=0.027），术后三天内低钾血症（OR，3.13；95CI，1.05-9.33；P=0.040），术后第一天和第二天血钠水平的差异≥1mEq/L（OR，3.65；95CI，1.05-12.77；P=0.043），和术后尿崩症(或，3.57；95CI，1.16-10.96；P=0.026）是DPH的独立预测因子。
结论：这种用于预测DPH的评分系统的受试者工作特征曲线（AUC）下面积为0.856（95CI，0.787-0.925），表明我们队列中DPH的中度到良好的预测价值，但需要进一步的前瞻性外部验证。
方法：我们回顾性分析了2019年1月至2022年12月接受内镜经蝶入路手术（TSS）的141例连续患者。根据术后第三天是否发生低钠血症将患者分为DPH组和非DPH（NDPH）组。采用多因素logistic回归分析确定DPH的预测因素,并基于这些预测因子构建了一个简单的评分系统。
结果：在141名患者中，36（25.5%）发展为DPH。多变量logistic回归分析显示年龄≥48岁(OR，3.74；95CI，1.14-12.21；P=0.029），Knosp等级≥3(OR,5.17；95CI，1.20-22.27；P=0.027），术后三天内低钾血症（OR，3.13；95CI，1.05-9.33；P=0.040），术后第一天和第二天血钠水平的差异≥1mEq/L（OR，3.65；95CI，1.05-12.77；P=0.043），和术后尿崩症(或，3.57；95CI，1.16-10.96；P=0.026）是DPH的独立预测因子。
结论：这种用于预测DPH的评分系统的受试者工作特征曲线（AUC）下面积为0.856（95CI，0.787-0.925），表明我们队列中DPH的中度到良好的预测价值，但需要进一步的前瞻性外部验证。
