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

作     者：Xiangming Cai An Zhang Peng Zhao Zhiyuan Liu Yiliyaer Aili Xinrui Zeng Yuanming Geng Chaonan Du Feng Yuan Junhao Zhu Jin Yang Chao Tang Zixiang Cong Yuxiu Liu Chiyuan Ma 

作者机构：Department of NeurosurgeryJinling HospitalNanjingChina School of MedicineSoutheast UniversityNanjingChina Department of Molecular Cell Biology and ImmunologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamNetherlands Department of NeurosurgeryThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina Department of NeurosurgeryThe Affiliated Jinling Hospital of Nanjing Medical UniversityNanjingChina Department of NeurosurgeryAffiliated Jinling HospitalMedical School of Nanjing UniversityNanjingChina Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingChina Department of BiostatisticsSchool of Public HealthSouthern Medical UniversityGuangzhouChina Department of NeurosurgeryJinling Hospitalthe First School of Clinical MedicineSouthern Medical UniversityNanjingChina 

出 版 物：《Chinese Neurosurgical Journal》 (中华神经外科杂志（英文）)

年 卷 期：2023年第9卷第4期

页      面：241-250页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：supported by Jiangsu Provincial Department of Science and Technology of China(grant no.BE2022821) the China Scholarship Council(CSC grant no.202206090022) 

主　　题：Endoscopic transsphenoidal surgery Nomogram Pituitary adenomas Postoperative delayed hyponatremia Predictors 

摘      要：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.