| Background:Based on the fact that neurocritical patients are prone to hypopituitarism,low serum T3 level is a strong predictor of poor prognosis and mortality in critically ill patients.Few reports,however,focus on neurocritical patients.The application of hormone replacement therapy(HRT)in neurocritical patients with low T3 syndrome also remains controversial.We studied the role of low T3 state as a predictor of outcomes in neurocritical patients and examined the effect of HRT on prognosis.Methods:A retrospective analysis was performed on the data of 32 neurocritical patients with low T3 syndrome who were admitted to the neuro-intensive care unit of Peking Union Medical College Hospital between January 2012 and October 2018.While 18/32(56.25%)patients received HRT(HRT group;n=18),14/32(43.75%)patients did not receive HRT(non-HRT group;n=14).Patients were followed up for periods ranging from 3 months to 72 months.Clinical and laboratory data were compared between the two groups using the Mann-Whitney U test or the t-test.Overall survival was assessed by the Kaplan-Meier curve and compared by the log-rank test.Univariate and multivariate regression analyses were identify the factors associated with prognosis and estimate the effect of HRT.We also assessed the influence of HRT on final neurological function,using the Glasgow Coma Scale(GCS)and the Glasgow Outcome Scale(GOS)scoresResults:The neurocritical events in our cohort included postoperative complications(n=18),traumatic brain injury(n=8),and spontaneous intracerebral hemorrhage(n=6).Mean GCS score in the cohort was 6.41(6.44±3.14 in HRT group vs.6.36± 2.06 in non-HRT group).A total of 15/32(46.87%)deaths were recorded(7 in the HRT group,8 in the non-HRT group).Overall survival was significantly shorter in the non-HRT group than the HRT group(16.45 months vs.47.47 months;P=0.034).In univariate regression analysis,the HRT group has the lower mortality risk than the non-HRT group,according to(HR=0.301,95%Cl:0.094-0.964;P=0.043).However,multivariate regression analysis showed no significant difference in mortality risk between the two groups(HR=0.340 95%CI:0.099-1.172;P=0.087).There was no significant difference in the short and long-term effects neurological function between the groups.Conclusion:Low T3 syndrome may influence the prognosis of neurocritical patients,and so changes in serum thyroid hormones level during treatment should be monitored.Although it is unclear to what extent can HRT improve the short or long-term outcome of neurological function,it can significantly benefit the survival of neurocritical patients.Background:Patients undergoing neurosurgical procedures complicated with water and sodium imbalance is very common,particularly in sellar tumor patients.Sellar surgery resulting in the impairments of hypophyseal portal vessels are common causes of hypopituitarism in postoperative neurosurgery patients,which is characterized by diabetes insipidus and electrolyte disturbance.The sodium imbalance that includes hypernatremia,which was considered one of the critical poor prognostic factors for neurosurgery patients.This study aimed to investigate the risk factors and the evolution of postoperative hypernatremia for sellar tumor patients.Methods:A total of 2702 patients with sellar tumor during January 2016 and December 2018 in the Department of Neurosurgery,Peking Union Medical College Hospital were included in this retrospective study.We collected demographic data;the essential clinical and operation data were also recorded.Data were analyzed for 578 patients with postoperative hypernatremia by using the SPSS 24.0.Results:Total of 578 patients were finally included in the analysis after inclusion and exclusion criteria were applied.There were 105 males(18.2%)and 473 females(81.8%)in this study,and the mean age of the cases was 41.88±15.68 years old.295 of 578(51.03%)patients returned to its normal sodium levels before discharge home in all.The operation was as follows:(craniotomy,n=46,8.0%vs microscopic endonasal transsphenoidal surgery,n=313,54.2%vs endoscopic endonasal transsphenoidal surgery,n=219,37.9%).116 of 578(20.1%)patients presented tumor recurrences.134 of 578 patients experienced intraoperative cerebrospinal fluid leakage,and 18 patients(3.1%)experienced postoperative cerebrospinal fluid leakage.Besides,30 patients(5.2%)suffered central nervous system infections after surgery.74 patients(12.80%)had phasic hyponatremia,and 441 patients(76.3%)developed diabetes insipidus.Among the 441 patients,97.3%of them were developed diabetes insipidus in 2 days after surgery.The condition was effectively controlled in 43.5%of diabetes insipidus patients.A statistical significance was found between preoperative serum sodium level(Estimate=0.144,P=0.008),operation time(Estimate=0.011,P=0.004),tumor volume(Estimate=0.269,P=0.047),postoperative intracranial infection(Estimate=1.590,P=0.001)and severity of hypernatremia.Conclusion:Postoperative patients with sellar tumors showed a high risk for hypernatremia within the main cause was diabetes insipidus.However,no direct effect of recovery of diabetes insipidus on the outcome of hypernatremia was found.In this study,nonfunctioning pituitary macroadenoma/huge adenomas,ACTH-secreting pituitary adenoma,and growth hormone-secreting pituitary adenoma were the common sellar tumors subclass complicated with postoperative hypernatremia.Preoperative serum sodium level,operation time,tumor volume,as well as postoperative intracranial infection,were the risk factors linked to severity of hypernatremia. |
