Department of Clinical Medicine and Surgery, China Medical University, Shenyang, China.
Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China.
Front Endocrinol (Lausanne). 2024 Oct 18;15:1463735. doi: 10.3389/fendo.2024.1463735. eCollection 2024.
To identify the risk factors of postoperative severe hyperkalemia after total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism (SHPT).
Data on 406 consecutive patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism at the General Hospital of Northern Theater Command between January 2013 and January 2023, were prospectively collected. Then, patients were divided into the training set (n=203) and the validation set (n=203) in a ratio of 1:1 by timeline. The patients were divided into severe hyperkalemia group and non-hyperkalemia group according to the postoperative serum kalium level >6.0 mmol/L with ECG changes or serum kalium level ≥6.5 mmol/L. Univariate and multivariate logistic regression analyses were used to evaluate the possible risk factors associated with postoperative severe hyperkalemia after TPTX. The predictive performance was evaluated with receiver operating characteristic (ROC) curves with the areas under the ROC curve (AUC) and calibration curve. Decision curve and clinical impact curve analyses were used to validate the clinical application of the value.
The incidence of postoperative severe hyperkalemia was 15.5% in all patients, 17.2% and 13.8% in the training and validation cohorts, respectively. The risk factors associated with postoperative severe hyperkalemia was higher preoperative kalium level. The optimal cut-off value for preoperative serum kalium level was 5.0mmol/L according to the ROC curve. The area under the curve (AUC) achieved good concordance indexes of 0.845 (95%CI, 0.776-0.914) in the training cohort. The sensitivities were 0.829 (95%CI: 0.663-0.934) and 0.857 (95%CI: 0.673-0.960) in the training and validation cohorts, respectively. The specificities were 0.798 (95%CI: 0.729-0.856) and 0.720 (95%CI:0.647-0.785) in the training and validation cohorts, respectively. Calibration curve exhibited a good consistency between actual observations and predicted severe hyperkalemia in the training and validation cohorts.
Our study found that the preoperative kalium levels is only a risk factor for postoperative severe hyperkalemia in patients undergoing TPTX for secondary hyperparathyroidism. The threshold for preoperative serum kalium levels is 5.0mmol/L that can serve as a useful indicator for identifying patients with severe hyperkalemia after surgery. These results provide valuable suggestion for clinical practice.
确定无自体移植的甲状旁腺全切除术（TPTX）后继发性甲状旁腺功能亢进（SHPT）患者术后严重高钾血症的危险因素。
前瞻性收集 2013 年 1 月至 2023 年 1 月期间北部战区总医院连续 406 例接受无自体移植的 TPTX 治疗的 SHPT 患者的数据。然后，根据术后血清钾水平>6.0mmol/L 伴心电图改变或血清钾水平≥6.5mmol/L，将患者按时间线以 1:1 的比例分为训练集（n=203）和验证集（n=203）。根据术后血清钾水平>6.0mmol/L（伴有心电图改变或血清钾水平≥6.5mmol/L），将患者分为严重高钾血症组和非高钾血症组。采用单因素和多因素逻辑回归分析评估与 TPTX 后严重高钾血症相关的可能危险因素。采用受试者工作特征（ROC）曲线评估预测性能，曲线下面积（AUC）和校准曲线。决策曲线和临床影响曲线分析用于验证该值的临床应用。
所有患者术后严重高钾血症的发生率为 15.5%，训练组和验证组分别为 17.2%和 13.8%。术前血钾水平较高是术后严重高钾血症的相关危险因素。根据 ROC 曲线，术前血清钾水平的最佳截断值为 5.0mmol/L。在训练队列中，曲线下面积（AUC）达到了良好的一致性指数 0.845（95%CI，0.776-0.914）。在训练组和验证组中，敏感性分别为 0.829（95%CI：0.663-0.934）和 0.857（95%CI：0.673-0.960）。特异性分别为 0.798（95%CI：0.729-0.856）和 0.720（95%CI：0.647-0.785）。在训练组和验证组中，校准曲线均显示出实际观察值与预测严重高钾血症之间的良好一致性。
本研究发现，术前血钾水平仅是接受无自体移植的甲状旁腺全切除术治疗继发性甲状旁腺功能亢进患者术后严重高钾血症的一个危险因素。术前血清钾水平的阈值为 5.0mmol/L，可作为术后严重高钾血症识别的有用指标。这些结果为临床实践提供了有价值的建议。
