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Change in serum sodium level predicts clinical manifestations of transurethral resection syndrome: a retrospective review.

Ishio J, Nakahira J, Sawai T, Inamoto T, Fujiwara A, Minami T - BMC Anesthesiol (2015)

Bottom Line: Logistic regression detected that the risk factors for being symptomatic were serum sodium level variables, operation time longer than or equal 90 min, and presence of continuous drainage from the bladder.ROC curve analysis showed that a change in serum sodium level of 7.4 mmol/l was the optimal cutoff value, with a sensitivity of 0.72, a specificity of 0.87, and an area under the curve (AUC) of 0.87.ROC curve analysis also showed that a 7.0% change in serum sodium level was optimal for this parameter, with a sensitivity of 0.70, a specificity of 0.89, and an AUC of 0.87.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. ane084@poh.osaka-med.ac.jp.

ABSTRACT

Background: Patients undergoing transurethral resection (TUR) of the prostate are at risk of TUR syndrome, generally defined as having cardiovascular and/or neurological manifestations, along with serum sodium concentrations less than or equal to 125 mmol/l. As these symptoms can also occur in patients with serum sodium greater than 125 mmol/l, this study aimed to investigate the relationship between serum sodium concentrations and neurological manifestations of TUR syndrome.

Methods: Data on patients who underwent TUR of the prostate under local anesthesia over an 8-year period were retrospectively reviewed. Based on their cardiovascular and neurological manifestations, patients were divided into two groups: a symptomatic and an asymptomatic group. Logistic regression analysis was used to detect the risk factors for being symptomatic. Receiver operator characteristic (ROC) curve analysis was used to determine the optimal cutoff value of estimated change in serum sodium level that could predict the development of clinical manifestation of TUR syndrome.

Results: Of the 229 patients, 60 showed symptoms. Serum sodium level correlated with neurological score (Spearman's correlation coefficient > 0.5). Logistic regression detected that the risk factors for being symptomatic were serum sodium level variables, operation time longer than or equal 90 min, and presence of continuous drainage from the bladder. ROC curve analysis showed that a change in serum sodium level of 7.4 mmol/l was the optimal cutoff value, with a sensitivity of 0.72, a specificity of 0.87, and an area under the curve (AUC) of 0.87. ROC curve analysis also showed that a 7.0% change in serum sodium level was optimal for this parameter, with a sensitivity of 0.70, a specificity of 0.89, and an AUC of 0.87.

Conclusions: Changes in serum sodium concentration of > 7 mmol/l and of > 7% could predict the development of cardiovascular and neurological manifestations, which were assumed to be symptoms of TUR syndrome.

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Related in: MedlinePlus

Correlations between neurological scores and serum sodium levels. Clinical neurological manifestations showed (A) an inverse correlation with minimum sodium level (Spearman’s correlation coefficient −0.59), and positive correlations with (B) changes in absolute sodium levels (Spearman’s correlation coefficient 0.58) and (C) percent changes in serum sodium levels (Spearman’s correlation coefficient 0.60). All p values were less than 0.001.
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Fig1: Correlations between neurological scores and serum sodium levels. Clinical neurological manifestations showed (A) an inverse correlation with minimum sodium level (Spearman’s correlation coefficient −0.59), and positive correlations with (B) changes in absolute sodium levels (Spearman’s correlation coefficient 0.58) and (C) percent changes in serum sodium levels (Spearman’s correlation coefficient 0.60). All p values were less than 0.001.

Mentions: Serum sodium levels in the symptomatic and asymptomatic groups were reduced by 14.9 ± 10.3 and 3.8 ± 4.5 mmol/l, respectively. These values were the absolute values in each patient and they were calculated as (preoperative sodium level) – (minimum sodium level). Percent change was calculated as (absolute value)/(preoperative sodium level). The change in serum sodium levels correlated with clinical neurological manifestations. Neurological manifestations were inversely correlated with minimum sodium concentration (Spearman’s correlation coefficient −0.59), and positively correlated with changes in absolute change of serum sodium concentrations (Spearman’s correlation coefficient 0.58) and percent change of serum sodium concentrations (Spearman’s correlation coefficient 0.60) (Figure 1).Figure 1


Change in serum sodium level predicts clinical manifestations of transurethral resection syndrome: a retrospective review.

Ishio J, Nakahira J, Sawai T, Inamoto T, Fujiwara A, Minami T - BMC Anesthesiol (2015)

Correlations between neurological scores and serum sodium levels. Clinical neurological manifestations showed (A) an inverse correlation with minimum sodium level (Spearman’s correlation coefficient −0.59), and positive correlations with (B) changes in absolute sodium levels (Spearman’s correlation coefficient 0.58) and (C) percent changes in serum sodium levels (Spearman’s correlation coefficient 0.60). All p values were less than 0.001.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4419475&req=5

Fig1: Correlations between neurological scores and serum sodium levels. Clinical neurological manifestations showed (A) an inverse correlation with minimum sodium level (Spearman’s correlation coefficient −0.59), and positive correlations with (B) changes in absolute sodium levels (Spearman’s correlation coefficient 0.58) and (C) percent changes in serum sodium levels (Spearman’s correlation coefficient 0.60). All p values were less than 0.001.
Mentions: Serum sodium levels in the symptomatic and asymptomatic groups were reduced by 14.9 ± 10.3 and 3.8 ± 4.5 mmol/l, respectively. These values were the absolute values in each patient and they were calculated as (preoperative sodium level) – (minimum sodium level). Percent change was calculated as (absolute value)/(preoperative sodium level). The change in serum sodium levels correlated with clinical neurological manifestations. Neurological manifestations were inversely correlated with minimum sodium concentration (Spearman’s correlation coefficient −0.59), and positively correlated with changes in absolute change of serum sodium concentrations (Spearman’s correlation coefficient 0.58) and percent change of serum sodium concentrations (Spearman’s correlation coefficient 0.60) (Figure 1).Figure 1

Bottom Line: Logistic regression detected that the risk factors for being symptomatic were serum sodium level variables, operation time longer than or equal 90 min, and presence of continuous drainage from the bladder.ROC curve analysis showed that a change in serum sodium level of 7.4 mmol/l was the optimal cutoff value, with a sensitivity of 0.72, a specificity of 0.87, and an area under the curve (AUC) of 0.87.ROC curve analysis also showed that a 7.0% change in serum sodium level was optimal for this parameter, with a sensitivity of 0.70, a specificity of 0.89, and an AUC of 0.87.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. ane084@poh.osaka-med.ac.jp.

ABSTRACT

Background: Patients undergoing transurethral resection (TUR) of the prostate are at risk of TUR syndrome, generally defined as having cardiovascular and/or neurological manifestations, along with serum sodium concentrations less than or equal to 125 mmol/l. As these symptoms can also occur in patients with serum sodium greater than 125 mmol/l, this study aimed to investigate the relationship between serum sodium concentrations and neurological manifestations of TUR syndrome.

Methods: Data on patients who underwent TUR of the prostate under local anesthesia over an 8-year period were retrospectively reviewed. Based on their cardiovascular and neurological manifestations, patients were divided into two groups: a symptomatic and an asymptomatic group. Logistic regression analysis was used to detect the risk factors for being symptomatic. Receiver operator characteristic (ROC) curve analysis was used to determine the optimal cutoff value of estimated change in serum sodium level that could predict the development of clinical manifestation of TUR syndrome.

Results: Of the 229 patients, 60 showed symptoms. Serum sodium level correlated with neurological score (Spearman's correlation coefficient > 0.5). Logistic regression detected that the risk factors for being symptomatic were serum sodium level variables, operation time longer than or equal 90 min, and presence of continuous drainage from the bladder. ROC curve analysis showed that a change in serum sodium level of 7.4 mmol/l was the optimal cutoff value, with a sensitivity of 0.72, a specificity of 0.87, and an area under the curve (AUC) of 0.87. ROC curve analysis also showed that a 7.0% change in serum sodium level was optimal for this parameter, with a sensitivity of 0.70, a specificity of 0.89, and an AUC of 0.87.

Conclusions: Changes in serum sodium concentration of > 7 mmol/l and of > 7% could predict the development of cardiovascular and neurological manifestations, which were assumed to be symptoms of TUR syndrome.

Show MeSH
Related in: MedlinePlus