Purpose

We aimed to describe and predict the risk of severe hypernatremia after surgical resection of craniopharyngioma and to identify the association of water intake, urine output, and sodium level change in the patients.

Method

The outcome was postoperative severe hypernatremia. We identified risk factors associated with hypernatremia using multivariable regression. We trained machine learning models to predict the outcome. We compared serum sodium change, intravenous input, oral input, total input, urine output, and net fluid balance according to different nurse shifts.

Results

Among 234 included patients, 125 developed severe hypernatremia after surgery. The peak incidence occurred during day 0 and day 6 after surgery. The risk was increased in patients with gross total resection (odds ratio (OR) 2.41, P < 0.001), high Puget classification (OR 4.44, P = 0.026), preoperative adrenal insufficiency (OR 2.01, P = 0.040), and preoperative hypernatremia (OR 5.55, P < 0.001). The random forest algorithm had the highest area under the receiver operating characteristic curve (0.770, 95% CI, 0.727–0.813) in predicting the outcome and was validated in the prospective validation cohort. Overnight shifts were associated with the highest serum sodium increase (P = 0.010), less intravenous input (P < 0.001), and less desmopressin use (P < 0.001).

Conclusion

The overall incidence of severe hypernatremia after surgical resection of craniopharyngioma was significant, especially in patients with gross total resection, hypothalamus distortion, preoperative adrenal insufficiency, and preoperative severe hypernatremia. Less intravenous input and less desmopressin use were associated with serum sodium increases, especially during overnight shifts.

中文翻译：

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颅咽管瘤患者术后护理中严重高钠血症

目的

我们的目的是描述和预测颅咽管瘤手术切除后严重高钠血症的风险，并确定患者饮水量、尿量和钠水平变化的关系。

方法

结果是术后严重高钠血症。我们使用多变量回归确定了与高钠血症相关的危险因素。我们训练机器学习模型来预测结果。我们根据不同护士轮班比较了血清钠变化、静脉输入、口服输入、总输入、尿量和净液体平衡。

结果

在 234 名患者中，125 名患者术后出现严重高钠血症。发病高峰发生在术后第 0 天和第 6 天。肉眼全切除（比值比 (OR) 2.41， P < 0.001）、高 Puget 分类（OR 4.44，P  = 0.026）、术前肾上腺皮质功能不全（OR 2.01，P  = 0.040）和术前高钠血症的患者风险增加（或 5.55，P < 0.001）。随机森林算法在预测结果方面具有最高的受试者工作特征曲线下面积（0.770，95% CI，0.727-0.813），并在前瞻性验证队列中得到了验证。夜班与血清钠增加最高 ( P  = 0.010)、静脉输入量减少 ( P < 0.001) 和去氨加压素使用量减少 ( P < 0.001)相关。

结论

颅咽管瘤手术切除后严重高钠血症的总体发生率显着，特别是在大体全切除、下丘脑扭曲、术前肾上腺皮质功能不全和术前严重高钠血症的患者中。静脉输入减少和去氨加压素使用减少与血清钠增加有关，尤其是在夜班期间。