背景:术后迟发性低钠血症(PDH)是垂体腺瘤(PAs)内镜经蝶入路手术(eTSS)后再入院的主要原因。然而,与PDH相关的危险因素尚未明确,用于预测PDH的动态在线列线图的开发尚未实现。我们旨在研究PDH的预测因素,并构建动态在线列线图以帮助其预测。
方法:我们分析了金陵医院神经外科2018年1月至2020年10月连续226例接受PASeTSS的患者数据。另外97名外部患者被纳入外部验证。PDH定义为血清钠水平低于137mmol/L,发生在术后第三天(POD)或更晚。
结果:POD1-2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)通过多变量logistic回归分析确定为PDH的预测因素。基于这些预测因素,在内部验证(调整后的AUC:0.613-0.688)和外部验证(AUC:0.594-0.617)中,我们构建了一个列线图,差异很大.此外,列线图在校准图中表现良好,Brier分数,和决策曲线分析。亚组分析显示,具有各种临床亚型和轻度至中度PDH的患者具有强大的预测性能。
结论:术前PT和单核细胞百分比,第一次,确定为PDH的预测因素。动态列线图被证明是预测PAs的eTSS后PDH的有价值的工具,并证明了良好的泛化性。患者可以从PDH的早期识别和优化的治疗决策中受益。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.