Predictors of Perioperative Hypertensive Crisis in Patients With Pheochromocytoma: A Retrospective Study
Bibliographic record
Abstract
Background: Pheochromocytoma is a rare adrenal gland tumor. The definitive treatment is an adrenalectomy. Because of its secretory nature, appropriate preoperative treatment is essential to prevent hypertensive crisis (HTC) during surgery. Despite this management, HTC is common and can cause life-threatening complications. We aimed to study variables that may affect HTC despite preoperative management. Methods: In a retrospective study, among 126 medical records of patients with adrenal tumors who were referred to Alzahra Hospital, Isfahan, Iran, between 2013 and 2021, 52 patients who took proper preparation for surgery were included. Results: Analysis of these patients (aged 15 - 72 years, 30 females) showed that 12 patients (23.1%) experienced HTC. The mean age in the HTC group was 44.0 ± 15.3 and in the non-HTC group was 45.6 ± 13.2 (P = 0.724). Among many potential predictors, we observed in a multivariate analysis that patients with tumors size > 33.5 mm were at higher risk for experiencing HTC (P = 0.038, odds ratio (OR): 13.1, confidence interval (CI): 1.26 - 135.26); taking amlodipine to help reduce blood pressures (BPs) was another significant predictor (P = 0.05, OR: 5.1, CI: 0.97 - 56.74). Mean values of systolic BP (SBP) and diastolic BP (DBP) before surgery in the HTC group were more, although it was not statistically significant. Patients' past medical history, 24-h urine metanephrine, normetanephrine, epinephrine, norepinephrine, vanillymandelic acid (VMA), and surgical technique were not significantly distributed between HTC and non-HTC patients (P > 0.05). Conclusion: Tumor sizes > 33.5 mm and the necessity of administering amlodipine to control BP were predictors of HTC. Due to the rarity of pheochromocytoma, multicenter studies with larger sample sizes for providing more reliable results are suggested. J Endocrinol Metab. 2023;13(1):20-32 doi: https://doi.org/10.14740/jem853
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".