Front Endocrinol (Lausanne). 2021 Mar 11;12:647610. doi: 10.3389/fendo.2021.647610. eCollection 2021.
A Predictive Nomogram for Red Blood Cell Transfusion in Pheochromocytoma Surgery: A Study on Improving the Preoperative Management of Pheochromocytoma.
Frontiers in endocrinology
Ying Guo, Lili You, Huijun Hu, Anli Tong, Xiaoyun Zhang, Li Yan, Shaoling Zhang
Affiliations
Affiliations
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China.
PMID: 33790869
PMCID: PMC8006300 DOI: 10.3389/fendo.2021.647610
Abstract
PURPOSE: Surgery is the major treatment option for pheochromocytoma but carries potential risks, including hemorrhage and hemodynamic instability. Even with laparoscopic adrenalectomy, intraoperative blood transfusion happens from time to time, but few studies have investigated risk factors. For the first time we develop and validate a nomogram for prediction of red blood cell transfusion in pheochromocytoma surgery.
METHODS: There were 246 patients in our center and 56 patients in Peking Union Medical College Hospital, who underwent pheochromocytoma surgery, enrolled in the study. We incorporated clinical and radiological risk factors, and presented this with a nomogram. Lasso regression model was used for feature selection. Logistic regression analysis was performed to identify the odd ratios. The performance of the nomogram was assessed with respect to its discrimination, calibration and clinical usefulness.
RESULTS: Thirty-two features were reduced to five, which were phenoxybenzamine use, phenoxybenzamine treatment duration, preinduction heart rate, tumor diameter and surgical procedure. The model showed good discrimination (C-index, 0.857; 95% CI, 0.781-0.836) and application in the validation sets also gave good discrimination (internal validation: C-index, 0.831; 95% CI, 0.750-0.822; external validation: C-index, 0.924; 95% CI, 0.766-1.000). Calibration tested with the Hosmer-Lemeshow test yielded a good agreement between prediction and observation (training P=0.358; internal validation P=0.205; external validation P=0.395). Odd ratios of phenoxybenzamine use, phenoxybenzamine treatment duration, preinduction HR, tumor diameter and open surgery were 13.32 (95% CI, 1.48-197.38; P = 0.034), 1.04 (95% CI, 0.99-1.08; P = 0.092), 1.04 (95% CI, 1.01-1.08; P=0.006), 1.03 (95% CI, 1.02-1.06; P<0.001), 17.13 (95% CI, 5.18-78.79; P<0.001), respectively. Decision curve analysis demonstrated the clinical usefulness of the nomogram.
CONCLUSIONS: This study presents a nomogram that may be used to facilitate the prediction of red blood cell transfusion in pheochromocytoma surgery and help to do the preoperative management more efficiently.
Copyright © 2021 Guo, You, Hu, Tong, Zhang, Yan and Zhang.
Keywords: blood transfusion; nomogram; pheochromocytoma; prediction model; surgery
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
- Lancet Oncol. 2015 Apr;16(4):e173-80 - PubMed
- Eur J Surg Oncol. 2020 Jun;46(6):991-998 - PubMed
- Med Decis Making. 2015 Feb;35(2):162-9 - PubMed
- Endocr Pract. 2015 Apr;21(4):368-82 - PubMed
- Ann Intern Med. 2012 Aug 21;157(4):294-5 - PubMed
- Urol Int. 2016;97(2):165-72 - PubMed
- Front Endocrinol (Lausanne). 2020 Nov 10;11:587779 - PubMed
- Biomed Pharmacother. 2005 Oct;59 Suppl 2:S334-6 - PubMed
- Oncotarget. 2017 Aug 22;8(45):79964-79970 - PubMed
- Int J Urol. 2019 Feb;26(2):212-216 - PubMed
- Int J Surg. 2014;12 Suppl 1:S72-4 - PubMed
- Br J Surg. 2020 Jan;107(2):e170-e178 - PubMed
- BMC Med Inform Decis Mak. 2020 Jul 20;20(1):165 - PubMed
- Clin Endocrinol (Oxf). 2017 Mar;86(3):309-314 - PubMed
- BMC Anesthesiol. 2020 Jun 12;20(1):147 - PubMed
- Int J Endocrinol. 2014;2014:658483 - PubMed
- Diabetes Care. 2020 Jan;43(Suppl 1):S14-S31 - PubMed
- World J Surg Oncol. 2019 Jun 29;17(1):111 - PubMed
- J Clin Endocrinol Metab. 2015 Feb;100(2):417-21 - PubMed
- Surgery. 2016 Mar;159(3):763-70 - PubMed
- J Clin Anesth. 2020 Apr 4;64:109794 - PubMed
- J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1427-1439 - PubMed
- Br J Anaesth. 2017 Feb;118(2):182-189 - PubMed
- Clin Endocrinol (Oxf). 2018 Mar;88(3):498-505 - PubMed
- Hypertens Res. 2020 Nov;43(11):1141-1151 - PubMed
- Gland Surg. 2020 Aug;9(4):869-871 - PubMed
- Clin Endocrinol (Oxf). 2017 Feb;86(2):163-167 - PubMed
- Ann Surg Oncol. 2015 Dec;22(13):4175-80 - PubMed
- Urology. 2017 Feb;100:131-138 - PubMed
- Endocr Pract. 2012 Sep-Oct;18(5):720-6 - PubMed
- J Clin Oncol. 2016 Jun 20;34(18):2157-64 - PubMed
- J Surg Oncol. 2018 Sep;118(4):709-715 - PubMed
- Ann Surg Oncol. 2015 Dec;22 Suppl 3:S646-54 - PubMed
- Nat Rev Endocrinol. 2020 Nov;16(11):621-622 - PubMed
- J Clin Endocrinol Metab. 2020 Sep 1;105(9): - PubMed
- J Clin Endocrinol Metab. 2014 Jun;99(6):1915-42 - PubMed
- BMJ Open. 2020 Sep 18;10(9):e041537 - PubMed
- Ann Oncol. 2020 Nov;31(11):1476-1490 - PubMed
Publication Types