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Li J, Zhang Z. Establishment and validation of a predictive nomogram for polyuria during general anesthesia in thoracic surgery. J Cardiothorac Surg 2024; 19:414. [PMID: 38956694 PMCID: PMC11220976 DOI: 10.1186/s13019-024-02833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/14/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND To develop and evaluate a predictive nomogram for polyuria during general anesthesia in thoracic surgery. METHODS A retrospective study was designed and performed. The whole dataset was used to develop the predictive nomogram and used a stepwise algorithm to screen variables. The stepwise algorithm was based on Akaike's information criterion (AIC). Multivariable logistic regression analysis was used to develop the nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the model's discrimination ability. The Hosmer-Lemeshow (HL) test was performed to check if the model was well calibrated. Decision curve analysis (DCA) was performed to measure the nomogram's clinical usefulness and net benefits. P < 0.05 was considered to indicate statistical significance. RESULTS The sample included 529 subjects who had undergone thoracic surgery. Fentanyl use, gender, the difference between mean arterial pressure at admission and before the operation, operation type, total amount of fluids and blood products transfused, blood loss, vasopressor, and cisatracurium use were identified as predictors and incorporated into the nomogram. The nomogram showed good discrimination ability on the receiver operating characteristic curve (0.6937) and is well calibrated using the Hosmer-Lemeshow test. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSIONS Individualized and precise prediction of intraoperative polyuria allows for better anesthesia management and early prevention optimization.
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Affiliation(s)
- Jiajie Li
- Department of Anesthesiology, Xinxiang Central Hospital, Xinxiang, Henan Province, 453000, China
| | - Zongwang Zhang
- Department of Anesthesiology, Liaocheng people's Hospital Affiliated to Shandong First Medical University, No. 67, Dongchang West Road, Dongchangfu District, Liaocheng, Shandong Province, 252004, China.
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Promi T, Tologonova G, Roberts MC, Tena M, Dhuper S, Bamgbola O, Hanono M, Weiss JP, Everaert K, DeBacker T, Monaghan T, Salciccioli L, Wadowski S, Jacobson-Dickman E, Lazar JM. Nocturia and Blood Pressure Elevation in Adolescents. J Community Health 2024; 49:379-384. [PMID: 38036797 DOI: 10.1007/s10900-023-01307-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
Nocturia has been increasingly recognized as a manifestation of various non-urological conditions including hypertension. In adults, blood pressure (BP) elevation has been identified as a robust correlate of nocturia, but such a relationship has not been studied in pediatric populations where nocturia is often attributed to hormonal, sleep, physiological or psychological disorders. Accordingly, this study aimed to determine the relationship between nocturia and BP elevation in adolescents. We prospectively studied 100 patients, aged 10-18 years, recruited from pediatric clinics at our institution. Nocturia (defined as ≥ 1 voids on voiding diary analysis) was present in 45% of the study sample (range: 1-4 voids/night). 37% of subjects self-reported awakening to urinate, and 34% of subjects had BP elevation according to age-dependent thresholds from current Pediatrics guidelines. On multivariate analyses, BP elevation was strongly associated with nocturia determined by both voiding diary (OR 26.2, 95% CI: 6.5, 106.0) and self-report. Conversely, nocturia was associated with increased odds of elevated BP by diary (26.3, 95% CI: 6.5, 106.4) and self-report (OR 8.1, 95% CI: 3.2, 20.5). In conclusion, nocturia appears to be common and is strongly associated with BP elevation in adolescents. These findings suggest that eliciting a history of nocturia holds promise as a simple method of identifying adolescents at risk for hypertension.
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Affiliation(s)
- Tasmia Promi
- Division of Cardiovascular Medicine, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1199, Brooklyn, NY, 11203- 2098, USA
| | - Gulzhan Tologonova
- Division of Cardiovascular Medicine, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1199, Brooklyn, NY, 11203- 2098, USA
| | - Marie-Claire Roberts
- College of Nursing, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Meseret Tena
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sarita Dhuper
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Oluwatoyin Bamgbola
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Monique Hanono
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Karel Everaert
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Tine DeBacker
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Thomas Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Louis Salciccioli
- Division of Cardiovascular Medicine, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1199, Brooklyn, NY, 11203- 2098, USA
| | - Stephen Wadowski
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Elka Jacobson-Dickman
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jason M Lazar
- Division of Cardiovascular Medicine, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1199, Brooklyn, NY, 11203- 2098, USA.
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Nocturnal Urine Production in Women With Global Polyuria. Int Neurourol J 2020; 24:270-277. [PMID: 33017897 PMCID: PMC7538286 DOI: 10.5213/inj.2040166.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/18/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Low nocturnal urine production (NUP) may be sufficient to rule out global polyuria (GP) in men. This study determines the sensitivity of indices for nocturnal polyuria (NP), defined as nocturnal polyuria index (NPi; nocturnal urine volume/24-hour urine volume) ≥0.33 or NUP ≥90 mL/hr, for detecting GP in women. METHODS Data were analyzed from 2 prospective protocols involving subjects recruited from a urology ambulatory care unit and a continence clinic. Women ≥18 years with nocturia were included if they met either of 2 common criteria for GP: (1) ≥40 mL/kg/24 hr or (2) ≥3,000 mL/24 hr. RESULTS Thirty-one women were included (NPi, 28.6 [21.3-40.7]; NUP, 100.8 [68.3-135.8] mL/hr). At the ≥40 mL/kg/24-hr cutoff, 40% and 63% of women reporting ≥1 nocturnal void(s) (n=30) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. Additionally, 53% and 71% of subjects reporting ≥2 nocturnal voids (n=17) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. At the ≥3,000 mL/24-hr cutoff, 38% and 69% of women reporting ≥1 nocturnal void(s) (n=13) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively, and 63% and 88% of subjects reporting ≥2 nocturnal voids (n=8) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. By extension, 37%-62% of women with nocturia and GP did not have NP by NPi ≥0.33 criteria, and 12%-37% did not have NP by NUP ≥90 mL/hr criteria. CONCLUSION Indices of excess nighttime urination do not reliably predict GP in women. A full-length voiding diary may be particularly important in the evaluation of women with nocturia. Nocturia in women merits further consideration as a distinct entity.
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