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
Abstract 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 fo...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-08-01
|
| Series: | Chinese Neurosurgical Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41016-023-00334-3 |
| _version_ | 1797752833544552448 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Xiangming Cai |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-12T17:10:12Z |
| format | Article |
| id | doaj.art-5897c6232c1b48889470c0d71de3ecec |
| institution | Directory Open Access Journal |
| issn | 2057-4967 |
| language | English |
| last_indexed | 2024-03-12T17:10:12Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Chinese Neurosurgical Journal |
| spelling | doaj.art-5897c6232c1b48889470c0d71de3ecec2023-08-06T11:07:10ZengBMCChinese Neurosurgical Journal2057-49672023-08-019111010.1186/s41016-023-00334-3Predictors and dynamic online nomogram for postoperative delayed hyponatremia after endoscopic transsphenoidal surgery for pituitary adenomas: a single-center, retrospective, observational cohort study with external validationXiangming Cai0An Zhang1Peng Zhao2Zhiyuan Liu3Yiliyaer Aili4Xinrui Zeng5Yuanming Geng6Chaonan Du7Feng Yuan8Junhao Zhu9Jin Yang10Chao Tang11Zixiang Cong12Yuxiu Liu13Chiyuan Ma14Department of Neurosurgery, Jinling HospitalDepartment of Neurosurgery, Jinling HospitalDepartment of Neurosurgery, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Neurosurgery, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Neurosurgery, The Affiliated Jinling Hospital of Nanjing Medical UniversitySchool of Medicine, Southeast UniversityDepartment of Neurosurgery, The Affiliated Jinling Hospital of Nanjing Medical UniversityDepartment of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing UniversityDepartment of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing UniversityDepartment of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing UniversityDepartment of Neurosurgery, Jinling HospitalDepartment of Neurosurgery, Jinling HospitalDepartment of Neurosurgery, Jinling HospitalDepartment of Critical Care Medicine, Jinling Hospital, Nanjing Medical UniversityDepartment of Neurosurgery, Jinling HospitalAbstract 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.https://doi.org/10.1186/s41016-023-00334-3Endoscopic transsphenoidal surgeryNomogramPituitary adenomasPostoperative delayed hyponatremiaPredictors |
| spellingShingle | 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 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 Endoscopic transsphenoidal surgery Nomogram Pituitary adenomas Postoperative delayed hyponatremia Predictors |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Endoscopic transsphenoidal surgery Nomogram Pituitary adenomas Postoperative delayed hyponatremia Predictors |
| url | https://doi.org/10.1186/s41016-023-00334-3 |
| work_keys_str_mv | AT xiangmingcai predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT anzhang predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT pengzhao predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT zhiyuanliu predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT yiliyaeraili predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT xinruizeng predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT yuanminggeng predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT chaonandu predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT fengyuan predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT junhaozhu predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT jinyang predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT chaotang predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT zixiangcong predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT yuxiuliu predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation AT chiyuanma predictorsanddynamiconlinenomogramforpostoperativedelayedhyponatremiaafterendoscopictranssphenoidalsurgeryforpituitaryadenomasasinglecenterretrospectiveobservationalcohortstudywithexternalvalidation |