Development and validation of a new model for predicting hypocalcaemia after total thyroidectomy: the NuGra model
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ORIGINAL ARTICLE
Development and validation of a new model for predicting hypocalcaemia after total thyroidectomy: the NuGra model Jennifer Triguero Cabrera 1 & Elena Fernández Segovia 1 & Selene González Martínez 1 & Nuria Victoria Muñoz Pérez 1 & Juan Ignacio Arcelus Martínez 1,2 & Manuela Expósito Ruiz 3 & Jesús María Villar del Moral 1 Received: 9 March 2020 / Accepted: 24 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Hypocalcaemia is the most frequent complication after total thyroidectomy. Finding a method for its early detection has become a priority. A single-center prospective cohort study was conducted to identify risk factors for postoperative hypocalcaemia, develop an early detection model, and test its validity in a different group of patients. Methods The sample was composed of patients who underwent a total thyroidectomy between May 2012 and September 2015. Demographic, clinical, laboratory, and surgical data were collected. The incidence of hypocalcaemia and permanent hypoparathyroidism was calculated. Bivariate and multivariate analysis identified several independent predictors of hypocalcaemia, which were used to design a predictive model. The validity of the model was subsequently tested in a different cohort. Area under the ROC curve (AUROC) was calculated to determine its predictive power. Results The study and validation groups included 352 and 118 patients, respectively. Seventy-three patients developed laboratory-confirmed hypocalcaemia (20.7%), and symptomatic in 43 (12.2%). Multivariate analysis confirmed as independent predictors of hypocalcaemia the higher number of parathyroid glands identified [OR 1.41(0.98, 2.02); p = 0.063] and pre-topostoperative gradient of parathormone decline [OR 1.06(1.04, 1.08); p < 0.001]. Based on these variables, the NuGra (Number of parathyroid glands identified-Gradient of decline) model was developed for predicting laboratory-confirmed hypocalcaemia. Its predictive power was high (AUROC 0.902, CI 0.857–0.947) for the study and the validation group (AUROC 0.956, CI 0.919–0.993). Conclusions A higher number of parathyroid glands identified and a higher gradient of parathormone decline are risk factors for post-thyroidectomy hypocalcaemia. The NuGra model is useful for early prediction of individual risk for hypocalcaemia. Keywords Hypocalcaemia . Total thyroidectomy . Parathyroid glands . Predictors
Abbreviations
iPTH
Intact parathormone
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-02002-x) contains supplementary material, which is available to authorized users. * Jennifer Triguero Cabrera [email protected]
Manuela Expósito Ruiz [email protected] Jesús María Villar del Moral [email protected]
Elena Fernández Segovia [email protected] Selene González Martínez [email protected] Nuria Victoria Muñoz Pérez [email protected] Juan Ignacio Arcelus Martínez [email protected]
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