FT4 is a novel indicator for risk assessment of severe hypocalcemia following parathyroidectomy.

IF 5.4 2区医学 Q1 Medicine

Journal of Endocrinological Investigation Pub Date : 2024-10-03 DOI:10.1007/s40618-024-02460-w

Xiao Liu, Weiqian Li, Chuancheng Huang, Zongyu Li

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引用次数: 0

Abstract

Objective: To analyze the risk factors associated with the development of severe hypocalcemia (SH) in patients who have undergone parathyroidectomy (PTX).

Methods: This research involved patients with chronic kidney disease-secondary hyperparathyroidism who underwent PTX between June 1, 2021, and May 31, 2023. SH was characterized by a serum total calcium (tCa) level below 1.8 mmol/L. This study aimed to analyze differences in preoperative laboratory findings and clinical manifestations between patients with and without SH. Logistic regression analysis was used to identify potential risk factors associated with the development of SH.

Results: The incidence of SH was 23% (n = 176). Significant differences were observed in free thyroxine (FT4), free triiodothyronine, alanine aminotransferase, osteocalcin, tCa, alkaline phosphatase (ALP), C-terminal cross-linked telopeptide of type I collagen, and parathyroid hormone between the SH and non-SH groups. The three independent risk factors for SH were tCa [odds ratio (OR) 0.063, 95% confidence interval (95% CI) 0.006-0.663], ALP (OR 1.003, 95% CI 1.001-1.005), and FT4 (OR 0.439, 95%CI 0.310-0.621). The area under the curve, sensitivity, specificity, and overall accuracy of this model were 0.904 (95% CI 0.856-0.952), 46.3%(95% CI 32.0%-61.3%), 94.8% (95% CI 89.7%-97.5%), and 83.5% (95% CI 77.3%-88.3%), respectively.

Conclusion: The preoperative level of FT4 plays a crucial role in predicting the risk of SH after PTX. The combined FT4-ALP-tCa model demonstrates the ability to predict SH risk, providing valuable insights for customizing calcium supplementation strategies and improving clinical decision-making.

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FT4 是评估甲状旁腺切除术后严重低钙血症风险的新指标。

目的分析甲状旁腺切除术（PTX）患者发生严重低钙血症（SH）的相关风险因素：本研究涉及2021年6月1日至2023年5月31日期间接受PTX手术的慢性肾脏病-继发性甲状旁腺功能亢进症患者。SH的特征是血清总钙（tCa）水平低于1.8 mmol/L。本研究旨在分析有SH和无SH患者术前实验室检查结果和临床表现的差异。采用逻辑回归分析确定与 SH 发生相关的潜在风险因素：SH发生率为23%（n = 176）。在游离甲状腺素（FT4）、游离三碘甲状腺原氨酸、丙氨酸氨基转移酶、骨钙素、tCa、碱性磷酸酶（ALP）、I型胶原的C端交联端肽和甲状旁腺激素方面，SH组和非SH组之间存在显著差异。SH的三个独立风险因素分别是tCa[几率比（OR）0.063，95%置信区间（95% CI）0.006-0.663]、ALP（OR 1.003，95% CI 1.001-1.005）和FT4（OR 0.439，95%CI 0.310-0.621）。该模型的曲线下面积、灵敏度、特异性和总体准确性分别为 0.904（95% CI 0.856-0.952）、46.3%（95% CI 32.0%-61.3%）、94.8%（95% CI 89.7%-97.5%）和 83.5%（95% CI 77.3%-88.3%）：术前FT4水平在预测PTX术后发生SH的风险中起着至关重要的作用。FT4-ALP-tCa联合模型显示了预测SH风险的能力，为定制补钙策略和改善临床决策提供了宝贵的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Endocrinological Investigation ENDOCRINOLOGY & METABOLISM-

CiteScore

8.10

自引率

7.40%

发文量

242

期刊介绍： The Journal of Endocrinological Investigation is a well-established, e-only endocrine journal founded 36 years ago in 1978. It is the official journal of the Italian Society of Endocrinology (SIE), established in 1964. Other Italian societies in the endocrinology and metabolism field are affiliated to the journal: Italian Society of Andrology and Sexual Medicine, Italian Society of Obesity, Italian Society of Pediatric Endocrinology and Diabetology, Clinical Endocrinologists’ Association, Thyroid Association, Endocrine Surgical Units Association, Italian Society of Pharmacology.