22q11.2 微缺失（22q11DS）患者心脏矫正手术后术后低钙血症严重程度与围手术期死亡率的相关性：回顾性分析。

The Correlation Between Severity of Postoperative Hypocalcemia and Perioperative Mortality in Chromosome 22q11.2 Microdeletion (22q11DS) Patient After Cardiac-Correction Surgery: A Retrospective Analysis.

机构信息

Department of Cardiothoracic Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.

出版信息

Heart Surg Forum. 2020 Aug 3;23(5):E549-E554. doi: 10.1532/hsf.2957.

DOI:10.1532/hsf.2957

PMID:32990587

Abstract

OBJECTIVES

The aim of our study was to elucidate the association between severity of postoperative hypocalcemia and the prognosis of the patients with 22q11DS.

METHODS

Data retrospectively were collected from 23 children with 22q11DS who underwent cardiac correction surgery. Area under the receiver operating characteristic curve (AUC) and diagnostic odds ratio were calculated to determine the tendency of perioperative mortality rate, according to the minimum levels of serum calcium and the duration of hypocalcemia. A novel risk assessment system for perioperative mortality was established according to these valid parameters.

RESULTS

The death group had lower minimum levels of serum calcium and longer duration of hypocalcemia. The AUC of minimum levels of serum calcium was 0.912 (95% CI: 0.753-1; P = .003) and qualified its high accuracy for perioperative mortality. The AUC of duration of hypocalcemia was 0.804 (95% CI: 0.561-1; P = .03) and qualified its moderate accuracy. The tendency analyses also indicated the correlation between these two parameters and perioperative mortality. Based on the cut-off values from ROC analysis, a novel risk assessment system for perioperative mortality was established according to these two parameters. The patients with the lowest serum calcium level <0.885 mmol/L or duration of the hypocalcemia > 90.33 hours would be sorted into a high-risk group; others were divided into a low-risk group. The diagnostic odds ratio for this assessment system was 143(95% CI: 5.13-3982.52). No significant difference was found with regard to patient age, weight, preoperative serum total calcium, cardiopulmonary bypass (CPB) time, and aortic cross-clamp time between the high- and low-risk groups.

CONCLUSIONS

The minimum levels of serum calcium and duration of hypocalcemia were valid predictors for preoperative mortality of 22q11DS patients.

摘要

目的

本研究旨在阐明术后低钙血症的严重程度与 22q11DS 患者预后之间的关系。

方法

回顾性收集 23 例 22q11DS 患儿心脏矫正手术后的数据。计算曲线下面积（AUC）和诊断比值比，以确定根据血清钙最低水平和低钙血症持续时间，围手术期死亡率的趋势。根据这些有效参数建立了一种新的围手术期死亡率风险评估系统。

结果

死亡组的血清钙最低水平和低钙血症持续时间均较低。血清钙最低水平的 AUC 为 0.912（95%CI：0.753-1；P =.003），具有较高的围手术期死亡率准确性。低钙血症持续时间的 AUC 为 0.804（95%CI：0.561-1；P =.03），具有中等准确性。趋势分析还表明了这两个参数与围手术期死亡率之间的相关性。基于 ROC 分析的截断值，根据这两个参数建立了一种新的围手术期死亡率风险评估系统。血清钙最低水平<0.885mmol/L 或低钙血症持续时间>90.33 小时的患者将被归入高危组；其他患者归入低危组。该评估系统的诊断比值比为 143（95%CI：5.13-3982.52）。高危组和低危组在患者年龄、体重、术前血清总钙、体外循环（CPB）时间和主动脉阻断时间方面无显著差异。