Strajina Veljko, Dy Benzon M, McKenzie Travis J, Thompson Geoffrey B, Lyden Melanie L
Am Surg. 2020 Feb 1;86(2):121-126.
We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9-10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy ( < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6-24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.
我们对大量患者队列进行了一项回顾性研究，旨在检验预测甲状腺切除术后低钙血症的能力。对2008年至2018年期间在我们机构接受全甲状腺切除术或近全甲状腺切除术的患者进行了回顾性分析。术后低钙血症定义为术后30天内血钙水平<8.0mg/dL（参考范围：8.9 - 10.1mg/dL）。采用逻辑回归建立预测术后低钙血症发生的模型。1463例患者符合纳入标准。223例患者（15%）记录有低钙血症。仅基于甲状旁腺激素（PTH）水平的模型的受试者工作特征曲线下面积（AUC）为0.79。甲状腺切除术后头两小时内，测量时间与PTH水平呈负相关（<0.01）。在切口关闭后2至6小时测量时，PTH的预测能力优于更早（切口关闭后头两小时内，AUC = 0.79）或更晚（切口关闭后6 - 24小时，AUC = 0.77）测量时（AUC = 0.82）。术后2至6小时测量时，PTH<19pg/mL对术后低钙血症的敏感性为90%，阴性预测值为96%。包含PTH水平、同时测量的总血钙水平和测量时间的模型预测能力有所提高，AUC为0.87。在我们的队列中，甲状腺切除术后2至6小时测量的PTH水平为19pg/mL时，敏感性为90%，阴性预测值为96%。包括术后PTH水平、血钙水平和测量时间的模型可能会进一步提高预测甲状腺切除术后低钙血症的能力。
