Preoperative Alkaline Phosphatase Research Articles

A nomogram prediction model for hungry bone syndrome in dialysis patients with secondary hyperparathyroidism after total parathyroidectomy

ObjectiveSecondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD). Hungry bone syndrome (HBS) after parathyroidectomy (PTX) is a serious complication, which can lead to diarrhea, convulsion, arrhythmia and even death. This study was aimed to determine the risk factors for HBS after PTX in dialysis patients with SHPT and construct a nomogram prediction model to predict the incidence of postoperative complications.MethodsClinical data were collected from 80 maintenance hemodialysis (MHD) patients with SHPT who received total PTX in the Second Hospital of Jilin University from January 2018 to September 2021. In line with the inclusion and exclusion criteria, totally 75 patients were finally enrolled for analysis. Patients were divided into two groups for retrospective analysis according to the severity of postoperative HBS, including HBS group and non-HBS (N-HBS) group. Univariate and multivariate logistic regression analyses were conducted to determine the risk factors for postoperative HBS. Afterwards, the receiver operating characteristic (ROC) curves were plotted based on the statistical analysis results, aiming to compare the prediction effects of different predicting factors. Finally, the nomogram was established to evaluate the occurrence probability of postoperative complications predicted by the risk factors.ResultsAmong the 75 patients, 32 had HBS (HBS group), while 43 did not have HBS (N-HBS group). Univariate analysis results indicated that, the preoperative intact parathyroid hormone (iPTH) and serum alkaline phosphatase (ALP) levels in HBS group were significantly higher than those in N-HBS group, while preoperative hemoglobin and preoperative albumin (Alb) levels were significantly lower than those in N-HBS group. As discovered by multivariate logistic regression analysis, preoperative iPTH (OR = 1.111, P = 0.029) and ALP (OR = 1.010, P < 0.001) were the independent risk factors for postoperative HBS. ROC curve analysis suggested that the area under the curve (AUC) values of these two indicators were 0.873 and 0.926, respectively (P < 0.0001). Subsequently, the nomogram model for predicting HBS was constructed. The model verification results indicated that the predicted values were basically consistent with the measured values, with the C-index of 0.943 (95% CI 0.892–0.994). Besides, the calibration curve was consistent with the ideal curve, demonstrating the favorable accuracy and discrimination of the model.ConclusionsPreoperative iPTH and preoperative ALP are the risk factors for postoperative HBS, which can be used to guide the early clinical intervention.

Elevated alkaline phosphatase independently predicts early postoperative complications in noninfectious revision total shoulder arthroplasty.

This study investigates the association between preoperative serum alkaline phosphatase levels and 30day postoperative complications following noninfectious revision total shoulder arthroplasty (TSA). We hypothesize that elevated alkaline phosphatase levels are significantly associated with an increased 30day postoperative complication rate. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent noninfectious revision TSA from 2015 to 2022. The study population was divided into two groups based on preoperative serum alkaline phosphatase: normal (44-147 IU/L) and elevated (> 147 IU/L). Logistic regression analysis was conducted to investigate the relationship between elevated alkaline phosphatase levels and postoperative complications. Compared to normal levels, elevated alkaline phosphatase was independently associated with a significantly greater likelihood of experiencing any complications (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.41-4.55; P = .002), sepsis (OR 9.96, 95% CI 1.67-59.29; P = .012), blood transfusions (OR 3.77, 95% CI 1.48-9.61; P = .005), readmission (OR 3.65, 95% CI 1.48-9.01; P = .005), and length of stay > 2days (OR 2.37, 95% CI 1.31-4.30; P = .004). Elevated preoperative alkaline phosphatase was associated with a greater rate of early postoperative complications following noninfectious revision TSA. Level III; Retrospective Cohort Comparison; Prognosis Study.

Risk factors for readmission after a cholecystectomy: a case-control study.

The aim of this study was to assess the risk factors associated with 30-day hospital readmissions after a cholecystectomy. We conducted a case-control study, with data obtained from UC-Christus from Santiago, Chile. All patients who underwent a cholecystectomy between January 2015 and December 2019 were included in the study. We identified all patients readmitted after a cholecystectomy and compared them with a randomized control group. Univariate and multivariate analyses were conducted to identify risk factors. Of the 4866 cholecystectomies performed between 2015 and 2019, 79 patients presented 30-day hospital readmission after the surgical procedure (1.6%). We identified as risk factors for readmission in the univariate analysis the presence of a solid tumor at the moment of cholecystectomy (OR = 7.58), high pre-operative direct bilirubin (OR = 2.52), high pre-operative alkaline phosphatase (OR = 3.25), emergency admission (OR = 2.04), choledocholithiasis on admission (OR = 4.34), additional surgical procedure during the cholecystectomy (OR = 4.12), and post-operative complications. In the multivariate analysis, the performance of an additional surgical procedure during cholecystectomy was statistically significant (OR = 4.24). Performing an additional surgical procedure during cholecystectomy was identified as a risk factor associated with 30-day hospital readmission.

Predictive analysis of severe hypocalcemia following total parathyroidectomy for renal secondary hyperparathyroidism.

This study aimed to evaluate the incidence and identify risk factors for severe hypocalcemia following total parathyroidectomy (TPTX) in patients with renal secondary hyperparathyroidism (SHPT). We included patients undergoing maintenance hemodialysis or peritoneal dialysis who underwent TPTX from January 1, 2018, to April 30, 2023. Participants were categorized into groups based on postoperative corrected serum calcium levels: severe hypocalcemia (<1.8 mmol/L) and non-severe hypocalcemia (≥1.8 mmol/L). We conducted univariate analyses of demographic and laboratory data to identify potential risk factors, which were further analyzed using a binary logistic regression model. Significant associations were observed with age, dialysis duration exceeding five years, type of dialysis (peritoneal dialysis), lower preoperative corrected serum calcium, elevated preoperative intact parathyroid hormone (iPTH), and increased preoperative alkaline phosphatase (ALP) levels (all p<0.05). Age, preoperative iPTH, and ALP levels were identified as independent risk factors for severe hypocalcemia post-TPTX. Younger patients with renal SHPT who have elevated preoperative iPTH and ALP levels are at an increased risk of experiencing severe hypocalcemia following TPTX. These findings underscore the importance of careful preoperative assessment and monitoring to mitigate the risk of this complication.

Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors.

Risk factors of gallbladder cancer (GBC) are not well-defined resulting in greater than 60% of GBCs being diagnosed incidentally following cholecystectomy performed for presumed benign indications. As most localized GBCs require more extensive oncologic surgery beyond cholecystectomy, this study aims to examine factors associated with incidentally found GBC to improve preoperative and intraoperative diagnoses. The American College of Surgeons National Surgical Quality Improvement Program Database from 2007 to 2017 was used to identify cholecystectomies performed with and without a final diagnosis of GBC. Univariate and multivariable logistic regressions were used to compare demographic, intraoperative, and postoperative characteristics among those with and without a diagnosis of GBC. The incidence of GBC was observed to be 0.11% (441/403,443). Preoperative factors associated with risk of GBC included age > 60 (OR 6.51, p < .001), female sex (OR 1.75, p < .001), history of weight loss (2.58, p < .001), and elevated preoperative alkaline phosphatase level (OR 1.67, p = .001). Open approach was associated with 7 times increased risk of GBC compared to laparoscopic approach (OR 7.33, p < .001). In addition to preoperative factors and surgical approach, longer mean operative times (127min vs 70.7min, p < .001) were significantly associated with increased risk of GBC compared to benign final pathology. This study demonstrates that those with incidentally discovered GBC at cholecystectomy are unique from those undergoing cholecystectomy for benign indications. By identifying predictors of GBC, surgeons can choose high risk individuals for pre-operative oncologic evaluation and consider better tools for identifying GBC such as intraoperative frozen pathology.

Secondary hyperparathyroidism combined with thyroid disease.

To retrospectively analyze the diagnosis and treatment of secondary hyperparathyroidism (SHPT) combined with thyroid disease, and to investigate the correlation between SHPT and papillary thyroid carcinoma (PTC), SHPT and thyroid disease, and the importance of preoperative localization diagnosis in patients with SHPT. Clinical data of 101 patients who underwent surgical treatment for SHPT at the Third Hospital of Hebei Medical University were collected from August 2014 to May 2023, and patients were divided into SHPT without PTC group (n = 94) and SHPT with PTC group (n = 7) according to their postoperative pathology. Patients were divided into SHPT without thyroid disease group (n = 32) and SHPT with thyroid disease group (n = 69) according to their preoperative ultrasound diagnosis and postoperative pathology. The differences between the 2 groups were compared to explore the association between SHPT and PTC and between SHPT and thyroid disease. Of the 101 patients with SHPT, 65 were male and 36 were female with a mean age of (44.26 ± 11.16) years. There were 69 patients (68.32%) with concomitant thyroid disease and 32 patients (31.68%) without concomitant thyroid disease, including 7 patients (6.93%) with PTC. The results of univariate analysis showed that the differences in age and preoperative PTH levels between the SHPT without PTC group and the SHPT with PTC group were statistically significant (P < 0. 05),There were no significant differences in age, gender, preoperative PTH, preoperative alkaline phosphatase, preoperative serum calcium, preoperative serum phosphorus, preoperative serum creatinine, duration of dialysis disease, and whether they were accompanied by hypertension or not between the SHPT without thyroid disease group and the SHPT with thyroid disease group (P > 0. 05), logistic regression analysis showed that there was a correlation between the age of patients with SHPT and the level of preoperative PTH with PTC. In patients with SHPT, concomitant thyroid disease is more common, so patients with SHPT should be screened for thyroid disease at the same time as routine preoperative ultrasonography combined with nuclear scan for localized diagnosis, and surgical resection is preferred if concomitant PTC is present.

Factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients.

Parathyroidectomy (PTX) is an effective treatment for primary hyperparathyroidism (PHPT) patients. Postoperative hypocalcemia is a common complication after PTX. This study aimed to analyze the factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients. The retrospective study included 270 PHPT patients treated with PTX and collected their demographic and clinical information and their laboratory indices. Factors influencing serum calcium levels and hypocalcemia after PTX in PHPT patients were analyzed using univariate and multifactorial analyses. First, in patients with normal preoperative serum calcium levels (2.20-2.74 mmol/L), the higher the preoperative alkaline phosphatase and serum phosphorus levels, the lower the postoperative serum calcium levels. Furthermore, the higher the preoperative serum calcium levels and the accompanying clinical symptoms, the higher the postoperative serum calcium levels. Low preoperative serum calcium levels were shown to be a risk factor for postoperative hypocalcemia (OR=0.022), and the optimal preoperative serum calcium threshold was 2.625 mmol/L (sensitivity and specificity were 0.587 and 0.712, respectively). Second, in the mild preoperative hypercalcemia group (2.75-3.00 mmol/L), the older the patient, the higher the preoperative and postoperative serum calcium levels, the higher the postoperative serum calcium; the lower the alkaline phosphatase and calcitonin levels, the higher the postoperative serum calcium levels. On the other hand, the younger the patient was, the more likely hypocalcemia blood was (OR=0.947), with an optimal age threshold of 47.5 years (sensitivity and specificity were 0.543 and 0.754, respectively). Third, in the preoperative moderate to severe hypercalcemia group (>3.0mmol/L), patients undergoing a combined contralateral thyroidectomy and a total thyroidectomy had low postoperative serum calcium levels. Patients with different preoperative serum calcium levels had various factors influencing their postoperative serum calcium levels and postoperative hypocalcemia, which facilitated the assessment of their prognosis.

Neck Reoperation for Recurrent or Persistent Renal Hyperparathyroidism.

Patients with renal hyperparathyroidism undergoing parathyroidectomy may experience relapse. Reoperation for persistent or recurrent disease, particularly in the neck region, is challenging and has a high complication rate because of difficult exploration. We aimed to evaluate the effectiveness of neck reoperation in renal hyperparathyroidism. Patients with recurrent or persistent renal hyperparathyroidism who underwent neck reoperation between January 2015 and August 2022 were investigated, focusing on operative findings, perioperative biochemical changes, and significance of intraoperative parathyroid hormone (PTH) measurements. During reoperation, 35 parathyroid glands were identified and removed from the 26 enrolled patients, with one, two, and three glands retrieved from 19 (73.2%), five (19.2%), and two (7.6%) patients, respectively. Most removed glands (68.6%) were located in the lower neck, followed by the mediastinum, carotid sheath, and upper neck. Successful resection, defined as a postoperative PTH level of <300pg/mL, was achieved in 21 patients (80.8%). The remaining four (15.4%) and one (3.9%) patients were classified as having persistent and recurrent disease, respectively. The extent of PTH reduction was correlated with specimen weight, specimen volume, and preoperative alkaline phosphatase (ALP) level. The mean intraoperative PTH ratio (10 min after excision/pre-excision) was 0.23, and all patients with persistent or recurrent disease had a PTH ratio >0.3. Severe hypocalcemia (<7.5mg/dL) occurred in 19 (73.0%) patients after reoperation. Neck reoperation is an effective therapeutic option in patients with recurrent or persistent renal hyperparathyroidism. A decrease in PTH level by >70% during reoperation (PTH ratio <0.3) predicts successful resection.

A New Calculation Model for Calcium Requirements After Parathyroidectomy in Patients With Secondary Hyperparathyroidism.

We aimed to develop a new calculation model for calcium requirements in dialysis patients following parathyroidectomy. A total of 98 patients with secondary hyperparathyroidism receiving parathyroidectomy from January 2014 to January 2022 were enrolled in this study. Among these patients, 78 were randomly selected for construction of the calcium requirement calculation model, and the remaining 20 patients were selected for model validation. The calcium requirement model estimated the total calcium supplementation for 1 week after surgery using variables with significant relationships in the derivation group by stepwise multiple linear regression analysis. Bias, precision, and accuracy were measured in the validation group to determine the performance of the model. The model was as follows: calcium requirement for 1 week after surgery=33.798-8.929×immediate postoperative calcium+0.190×C-reactive protein-0.125×age+0.002×preoperative intact parathyroid hormone+0.003×preoperative alkaline phosphatase (R2=0.8). The model was successfully validated. We generated a novel model to guide calcium supplementation. This model can assist in stabilizing the serum calcium levels of patients during the early postoperative period. Furthermore, it contributes to the individualized and precise treatment of hypocalcemia in patients following parathyroidectomy.

Clinical characteristics of primary parathyroid adenoma and its relationship with coexisting papillary thyroid carcinoma: a clinical retrospective study.

Parathyroid adenoma (PA) is a common but relatively poorly understood endocrine tumor. A significant number of PA patients also have papillary thyroid carcinoma (PTC). The clinicopathological characteristics of PA and its relationship with PTC need further study. The clinical data of 99 PA patients were reviewed and the clinicopathologic features of PA were analyzed. PTC occurred in 22 PA patients. The clinicopathologic features of 22 patients with PA + PTC and 77 patients with PA alone were compared. According to age, gender and thyroid surgery methods, 22 PA + PTC patients were matched with 1,123 patients with PTC alone during the same period. The pathological characteristics of the two groups of patients were compared. All data analysis was performed using SPSS23.0, variables were compared by t-test, chi square test or Mann Whitney U-test as appropriate. Ninety-nine PA patients (21 males, 78 females) with a median age of 51 [10-80] years were included. The preoperative parathyroid hormone (PTH) (P=0.007) and preoperative blood calcium (P=0.036) of male patients were higher than those of female patients, and the proportion of asymptomatic patients (P=0.008) and postoperative PTH level (P=0.013) were lower. The preoperative PTH level (P=0.002), preoperative blood calcium level (P=0.004), preoperative alkaline phosphatase (ALP) level (P=0.018) and postoperative PTH levels (P=0.023) in PA + PTC group were lower than those in PA group. The asymptomatic rate was higher in PTC + PA group than that in PA group (P<0.001). There was no statistical difference between PA + PTC group and PTC group in multifocal tumor, capsule invasion, lymph node metastasis (P>0.05). The lymph node metastasis rate in PA + PTC group (9/215) was significantly lower than that in PTC group (37/337) (P=0.005). PA exhibited the following characteristics: occurred in all age groups; more common in women but more severe in men; more located in the lower pole. The coexistence of PTC and PA did not promote the progression of PA, nor did it increase the aggressiveness of PTC. Conversely, their co-existence may lead to early diagnosis of the disease. PA patients (22.2%) also have PTC, so surgeons should pay attention to thyroid disease to prevent the need for reoperation.

Characterization of primary hyperparathyroidism based on target organ involvement: An analysis from the Indian PHPT registry.

It has been a matter of debate for long time about the existence of two distinct phenotypes of primary hyperparathyroidism (PHPT) predisposed to either renal or skeletal manifestation. To differentiate characteristics of symptomatic PHPT patients based on the presence of skeletal or renal involvement. Retrospective analysis of data from the Indian PHPT registry. PHPT patients were divided into four discrete groups: asymptomatic, presenting with renal manifestations alone, skeletal manifestations alone, and both skeletal and renal manifestations. Clinical, biochemical, and tumour weight and histopathological characteristics of these groups were compared. Of the 229 eligible patients, 45 were asymptomatic, 62 had renal manifestations, 55 had skeletal manifestations, and 67 had both skeletal and renal manifestations. Patients with both skeletal and renal manifestations had higher serum calcium levels than those with isolated skeletal involvement [12.5 (11.1-13.7) mg/dL, 11.2 (10.6-12.3) mg/dL, respectively; p < .05]. Serum alkaline phosphatase (AP), plasma parathyroid hormone (PTH) levels, and parathyroid tumour weight were significantly higher in patients with isolated skeletal, and both skeletal and renal manifestations, compared to the other two groups. A preoperative PTH and AP level of 300 pg/mLand 152 U/L, predicted the risk of developing skeletal involvement with sensitivity and specificity of 71%, 70%, and 69%, 67%, respectively. We observed distinct skeletal and renal phenotypic subgroups among PHPT patients with characteristic biochemical and hormonal patterns with higher parathyroid disease burden in patients with skeletal complications compared to those with isolated renal manifestation.

ASSOCIATION BETWEEN SERUM ALP LEVELS AND PRE-OPERATIVE LDH TOWARDS CLINICAL PROGNOSIS OF OSTEOSARCOMA PATIENTS IN H. ADAM MALIK HOSPITAL, MEDAN

Background: The prognosis of osteosarcoma is very unsatisfactory due to frequent tumor metastases to the lung or resistance to chemotherapy. A marker is needed to identify the prognosis of patients with osteosarcoma when diagnosed with the aim of being able to receive cancer treatment as soon as possible to improve a better prognosis. Alkaline phosphatase (ALP) and Lactate dehydrogenase (LDH) have potential in assessing the prognosis in osteosarcoma.&#x0D; Purpose and Objectives: The researcher wanted to investigate the relationship between preoperative serum ALP and LDH levels on the clinical prognosis of osteosarcoma patients.&#x0D; Methods: This research is analytic retrospective with the source of data is medical records and was conducted at the Department of Surgery FK-USU/RSUP Haji Adam Malik Medan with research code of ethics No. 426/KEPK/USU/2022. The subjects of this study were patients with osteosarcoma who were treated at Division of Orthopedic Surgery at Haji Adam Malik Hospital Medan from January 2015-December 2017 who met the inclusion criteria.&#x0D; Results: There was no significant relationship between ALP and LDH with five-year survival with p-values ​​of 0.557 and 0.179 (p&gt;0.05). ALP has a weak correlation with five-year survival with an r value of -0.019 which means the higher the ALP, the lower the five-year survival of the patient. Meanwhile, LDH has a weak correlation with an r value of 0.093, which means the higher the LDH, the higher the patient's five-year survival. The ALP value in this study had a median value of 212 U/L and an LDH value of 489 U/L. ALP has sensitivity of 61.1% and specificity of 57.1% with a cut-off of 217.5 U/L. Meanwhile, LDH sensitivity was 61.2% and specificity was 51.4% with a cut-off of 488.5 U/L.&#x0D; Conclusion: There is no significant relationship between ALP and LDH with five-year survival.

Alkaline Phosphatase is an Independent Risk Factor for Periprosthetic Fractures in Total Joint Arthroplasty.

Serum alkaline phosphatase (ALP) is a biomarker for chronic low-grade inflammation along with hepatobiliary and bone disorders. High abnormal ALP levels in blood have been associated with metabolic bone disease and high bone turnover. All primary total hip and knee arthroplasties from 2005 to 2019 were queried from the National Surgical Quality Improvement Program database. Patients with available serum ALP levels were included and stratified to low (<44 IU/L), normal (44 to 147 IU/L), and high (>147 IU/L). A risk-adjusted multivariate logistic regression was used to analyze ALP as an independent risk factor of complications. The analysis included 324,592 patients, consisting of 11,427 low ALP, 305,977 normal ALP, and 7,188 high preoperative ALP level patients undergoing total joint arthroplasty. Adjusted multivariate logistic regression analysis showed high ALP level patients had an overall increased risk of readmission within 30 days of surgery compared with the control group (odds ratio [OR], 1.69; P < 0.01). High ALP patients also had an increased risk of postoperative periprosthetic fracture (OR, 1.6), postoperative wound infection (OR, 1.81), pneumonia (OR, 2.24), renal insufficiency (OR, 2.39), cerebrovascular disease (OR, 2.2), postoperative bleeding requiring transfusion (OR, 1.83), sepsis (OR, 2.35), length of stay > 2 days (OR, 1.47), Clostridium difficile infection (OR, 2.07), and discharge to a rehab facility (OR, 1.41) (all P < 0.05). A low ALP level was also associated with increased postoperative bleeding transfusion risk (OR, 1.12; P < 0.01) and developing a deep vein thrombosis (OR, 1.25; P = 0.03). Abnormal serum ALP levels in patients undergoing primary total joint arthroplasty are associated with increased postoperative periprosthetic fracture risk and medical complications requiring increased length of stay and discharge to a rehabilitation facility.

PSAT167 Asian-Indians With Symptomatic Primary Hyperparathyroidism Have Lower Body Weight At Presentation And Tend To Gain Weight Post-Curative Parathyroidectomy

Abstract Patients with primary hyperparathyroidism (PHPT) have higher body weight than their eucalcemic peers (1). However, most of the data is based on Caucasian PHPT patients who predominantly have an asymptomatic presentation. Similar data from Asian-Indian patients with PHPT who primarily have symptomatic disease are unavailable. In this regard, we planned to conduct a retrospective observational study to look into the dynamics of body weight in Asian-Indian PHPT patients. The medical records of PHPT patients (≥18 years) managed at Postgraduate Institute of Medical Education and Research, India, from July 2005 to December 2020 were retrieved from the Indian PHPT Registry (www.indianphptregistry.com). Patients who had achieved biochemical cure after parathyroidectomy with documentation of preoperative and at least one postoperative body weight 6 months to 2 years after surgery were included. Patients with recurrent/persistent/syndromic PHPT, chronic kidney disease (eGFR &amp;lt;90 ml/min/1.73 m2), parathyroid carcinoma, and incomplete records were excluded. After exclusion, a total of 243 patients were included in analysis (mean age=43.9±13.7 years, women 79.8%). The majority of the patients had symptomatic disease, while only 43 patients (18%) were asymptomatic at presentation. The predominant presenting manifestations were renal stone disease (52%), bone pain (40%), gastrointestinal symptoms (anorexia, nausea, vomiting, constipation) (30%), generalized weakness (26%), weight loss (23%), fragility fractures (16%), cholelithiasis (13%) and acute pancreatitis (7%). The mean preoperative body weight was 59.9±13.4 kg. Patients with PHPT had lower body weight compared to an equal number (n=243) of age- and sex-matched community-dwelling healthy controls (p&amp;lt;0.001 for both men and women). At median follow-up of 1 year, the mean postoperative body weight was 64.7±12.6 kg. The median (interquartile range) percent change is body weight was +6.7% (+2.1, +14.0). Increase in body weight was noted in 198 patients (81.5%). Univariate analysis showed that patients with postoperative weight gain were younger (p=0.029), had lower body weight (p&amp;lt;0.001), were more likely to be symptomatic (p=0.002), and more likely to have weight loss (p=0.041) and gastrointestinal symptoms (p=0.016) at presentation compared with patients with no weight gain. Similarly, patients with weight gain had significantly higher preoperative serum calcium (p=0.044), alkaline phosphatase (ALP) (p=0.001), and parathyroid hormone levels (p=0.001), indicating biochemically severe disease On binomial logistic regression analysis, preoperative body weight (β= -0.045, p=0.04), symptomatic presentation (β=0.217, p=0.02), and ALP (β=0.003, p=0.04) emerged as significant predictors of postoperative weight gain. In conclusion, Asian-Indians with symptomatic PHPT have lower body weight than healthy controls, likely because of significant gastrointestinal manifestations that compromise food intake. It is plausible that following reinstatement of eucalcemia, appetite improves, resulting in increased food intake and subsequent weight gain. Nevertheless, long-term follow-up studies evaluating the metabolic consequences of this postoperative weight gain are needed.Reference: (1) Bolland et al., J Clin Endocrinol Metab. 2005;90(3): 1525–30. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

A reappraisal of risk factors for early hypocalcemia after parathyroidectomy in dialysis patients.

We aimed to identify risk factors for early hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism. We retrospectively enrolled 106 of 120 consecutive patients with secondary hyperparathyroidism who underwent parathyroidectomy between January 2019 and July 2021. Perioperative laboratory parameters, preoperative computerized tomography (CT) images, and postoperative histology were evaluated. Parathyroid calcification was defined as hyperdense regions with a density of > 130 Hounsfield Units on CT images of the parathyroid. Subtotal parathyroidectomy, total parathyroidectomy without auto-transplantation, or total parathyroidectomy with auto-transplantation were performed in the present study. Postoperative hypocalcemia was defined as a serum calcium concentration < 2.1mmol/L within 4days of surgery. The participants were categorized according to the presence (n = 33) or absence (n = 73) of postoperative hypocalcemia. The demographics, comorbidities, and surgical details were similar in the two groups. Multivariate analysis showed that the preoperative alkaline phosphatase activity, serum intact parathyroid hormone and calcium concentrations, and parathyroid calcification were independent risk factors for postoperative hypocalcemia (all P < 0.05). Receiver operating characteristic analysis generated areas under the curves for preoperative alkaline phosphatase, intact parathyroid hormone, and parathyroid calcification of 0.82, 0.80, and 0.70, respectively (all P < 0.05). Cut-off values for preoperative alkaline phosphatase (> 242.9IU/L) and intact parathyroid hormone (> 2,104pg/mL) were found to be predictive of postoperative hypocalcemia. High preoperative alkaline phosphatase activity and serum intact parathyroid hormone concentration and low serum calcium are associated with higher risks of postoperative hypocalcemia. Calcification of the parathyroid may represent a novel radiologic means of predicting postoperative hypocalcemia.

Factors influencing the development of bone starvation syndrome after total parathyroidectomy in patients with renal hyperparathyroidism.

PurposeTo investigate the factors affecting the development of bone starvation syndrome (HBS) after total parathyroidectomy in patients with renal hyperparathyroidism (SHPT).Patients and methodsThe clinical data and perioperative indices of 141 patients who underwent PTX for SHPT were retrospectively analyzed. The patients were divided into HBS and non-HBS groups based on postoperative minimum blood calcium <1.87 mmol/L. The differences in general clinical data and perioperative related indices between the two groups were compared; logistic regression analysis was performed to analyze the risk factors influencing HBS occurrence after surgery. Multiple linear regression method was used to analyze the factors influencing the maintenance time of intravenous calcium supplementation and total amount of calcium supplementation during intravenous calcium supplementation. The threshold value for the diagnosis of HBS was analyzed using the ROC subjects' working curve.ResultsHBS occurred in 46 (32.6%) patients. Univariate analysis showed statistically significant differences in dialysis age, preoperative calcitonin, preoperative parathyroid hormone, preoperative blood phosphorus, and preoperative alkaline phosphatase between both groups (P < 0.05). Logistic regression analysis using stepwise entry method concluded that preoperative alkaline phosphatase was an independent factor for the development of HBS after surgery. Preoperative parathyroid hormone was an independent factor for the duration of intravenous calcium supplementation and total calcium supplementation during intravenous calcium supplementation in the HBS group. Based on the ROC curve, for postoperative HBS, the cut-off ALP value was 199.5 U/L, with a sensitivity of 80.85% and specificity of 82.61%.ConclusionPreoperative serum ALP may be an independent factor for HBS occurrence after surgery. When preoperative ALP > 199.5 U/L, patients with SHPT are prone to HBS after surgery, and the higher the preoperative ALP, the higher the incidence of HBS, and vice versa. In addition, preoperative PTH may be the factor in the timing of postoperative intravenous calcium supplementation and the total amount of calcium supplementation during intravenous calcium supplementation in patients with HBS.

Prognostic value of preoperative serum alkaline phosphatase for predicting 3-year mortality in patients undergoing kidney transplantation: A retrospective study.

Serum alkaline phosphatase (ALP) levels are related to high-turnover bone disease and reflect vascular calcification and inflammation. ALP has been reported to have a prognostic impact in various cohorts including chronic kidney disease. This study investigated whether preoperative serum ALP level could be used for predicting mortality in patients undergoing kidney transplantation. We retrospectively reviewed 1,718 patients who underwent kidney transplantation between November 2005 and June 2017. Finally, 1,533 patients who met the inclusion criteria were classified into tertiles based on preoperative serum ALP level (< 51, 51–72, > 72 IU/L). The incidence of mortality was compared among the three tertiles, and a stepwise logistic regression analysis was performed to evaluate the predictors for mortality. The incidence of 3-year mortality was the highest in the third tertile (1.0% vs. 2.5% vs. 4.4% in the first, second, and third tertile, respectively, p = 0.003). The third tertile of ALP level (odds ratio [OR] 1.855, 95% CI 1.192–2.886, p = 0.006), age (OR 1.052, 95% CI 1.022–1.082, p = 0.011), and history of hypertension (OR 0.401, 95% CI 0.210–0.765, p = 0.006) remained as independent predictors of mortality. Preoperative serum ALP level was significantly higher in the non-survivor group than in the survivor group (58.00 [44.00–76.00] vs. 75.00 [56.25–113.00], p = 0.003). The optimal cut-off value of serum ALP to predict 3-year mortality was 71 IU/L (area under the curve 0.636, 95% CI 0.554–0.719, p = 0.003). Therefore, preoperative serum ALP level was an independent predictor of 3-year mortality in patients undergoing kidney transplantation.

Lateral Pterygoid Muscle Ossification After Intraoral Condylectomy.

Lateral pterygoid muscle ossification has not been reported in condylectomy patients. This study aimed to explore the incidence, risk factors, and imaging characteristics of 38 cases with lateral pterygoid muscle ossification among 54 patients after condylectomy via intraoral approach. This retrospective study included 54 patients following simultaneous orthognathic surgery and condylectomy with coronoid process resection via intraoral approach. The authors evaluated the preoperative, 1 week, 6 months, and 1 year or more postoperative computed tomographic (CT) scans for the presence of lateral pterygoid muscle ossification and its characteristics. Sex, age at the time of surgery, disease course, affected side, preoperative alkaline phosphatase, pathology diagnosis, the height of the removed condyle, condylar shape, operator, preoperative temporomandibular joint movement, and clinical symptoms were assessed as risk factors for ossification. No incidence of lateral pterygoid muscle ossification was found on preoperative CT images. Various small-size osseous masses were observed in the lateral pterygoid muscles on postoperative 6 months CT images in 38/54 patients (70.37%) after condylectomy. But no apparent enlargement of the osseous masses was found. No patients complained of clinical discomfort or functional disorder during the follow-up period (23.11 ± 13.16 months). No significant risk factors for ossification were found. Lateral pterygoid muscle ossification is relatively common in patients after condylectomy via intraoral approach. However, its enlargement is self-limited and remains stable 6 months after surgery. it has no adverse effects on the temporomandibular joint functional movement.

Preoperative Serum Alkaline Phosphatase and Neurological Outcome of Cerebrovascular Surgery.

This study evaluated the relationship between the preoperative alkaline phosphatase (ALP) level and major postoperative neurological complications in patients undergoing cerebral bypass surgery. This was a retrospective analysis of a prospective database of all patients undergoing cerebral bypass surgery after a diagnosis of cerebrovascular stenosis or occlusion between May 2003 and August 2017. The patients were divided into tertiles based on serum alkaline phosphatase (ALP) levels (low: <63, intermediate: 63~79, and high: ALP > 79 IU/mL). The incidence of neurological events according to ALP level was analyzed. The study analyzed 211 cases. The incidence of acute infarction was highest in the third serum ALP tertile (5.7% vs. 2.9% vs. 16.9% in the first, second, and third tertile, respectively, p = 0.007). Logistic regression analysis showed that the third tertile of serum ALP was an independent predictor of acute cerebral infarction (odds ratio 3.346, 95% confidence interval 1.026–10.984, p = 0.045). On Kaplan–Meier time-to-event curves, the incidence of acute infarction increased significantly with ALP (log rank = 0.048). Preoperative serum ALP level can be used as a biomarker to predict acute cerebral infarction in patients undergoing cerebral bypass surgery for vascular stenosis or occlusion.

Diagnostic value of gamma-glutamyl transferase and alkaline phosphatase for cholecystolithiasis complicated with occult pancreaticobiliary reflux

Objective: To explore the diagnostic value of the preoperative liver function for occult pancreaticobiliary reflux (OPBR) in patients with gallstones. Methods: Patients with gallstones in Shanghai East Hospital were enrolled from December 2020 to June 2021. Their intraoperative bile and clinical data were collected. According to the gallbladder bile amylase level, patients were divided into the OPBR group (bile amylase>110 U/L) and the control group (bile amylase ≤ 110 U/L). Preoperative liver function levels of the two groups were compared, and the differential parameters were accessed by the receiver operating characteristic (ROC) curve. And the risk factors for OPBR were tested by multiple logistic regression analysis. Results: Among 249 patients, 83 were male and 166 were female, aged 50 (37, 62) years; There were 218 cases in control group, including 70 males and 148 females, aged 49 (36, 61) years; There were 31 patients in the OPBR group, including 13 males and 18 females, aged 58 (51, 65) years. For preoperative liver function, gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) in the OPBR group were higher than those in the control group [35 (18, 59) vs 19 (13, 34) U/L, 80 (71, 97) vs 69 (57, 83) U/L; both P<0.01]. ROC indicated that preoperative GGT and ALP had important predictive values for OPBR in gallstone patients. Their respective optimal cut-off value and area under the ROC curve [AUC (95%CI)] were GGT ≥ 30 U/L, 0.656 (0.542-0.770), P=0.005; ALP≥70 U/L, 0.693 (0.613-0.773), P=0.001, respectively. In addition, multivariate logistic regression analysis showed that the levels of GGT [OR (95%CI)=2.856 (1.260-6.473), P=0.012] and ALP [OR (95%CI)=3.685 (1.314-10.333), P=0.013] were independent-related factors for OPBR in patients with gallstones. Conclusion: Preoperative liver function assessment is of great significance for patients with gallstones, while GGT and ALP are important for predicting OPBR in patients with gallstones.