Primer Hiperparatiroidi Tanılı Hastalarda Hematolojik İnflamatuar Belirteçler ile Postoperatif Hipokalsemi Arasındaki İlişki

Abstract

Amaç: Primer hiperparatiroidizm (PHPT), hiperkalsemi ile karakterize olan ve sıklıkla paratiroid adenomu (PTA) ile ilişkili yaygın bir endokrin hastalığıdır. Hipokalsemi PHPT'li hastalarda sık görülen bir postoperatif komplikasyondur. Nötrofil-lenfosit oranı (NLR) ve platelet-lenfosit oranı (PLR) ucuz hematolojik inflamatuar belirteçlerdir. PHPT'li hastalarda erken postoperatif hipokalsemi için hemogramdan türetilmiş inflamatuar belirteçler dahil olmak üzere potansiyel prediktif risk faktörlerini araştırmayı amaçladık. Gereç ve Yöntem: PHPT tanısı alan, paratiroidektomi uygulanan ve histopatolojik olarak tek PTA’dan kaynaklandığı gösterilen hastalar çalışmaya dahil edildi. Bulgular: NLR, parathormon (PTH) ile, PLR ise sadece NLR ile anlamlı düzeyde ilişkiliydi. Gland ağırlığı ve hacmi ile kalsiyum (Ca) ve PTH düzeyleri arasında anlamlı pozitif korelasyon gösterildi. Postoperatif hipokalseminin yaş, ameliyat öncesi Ca, PTH ve NLR ile anlamlı bir korelasyonu da gösterilmiştir. Sonuç: Postoperatif hipokalsemi gelişen PHPT'li hastalarda NLR'nin anlamlı derecede yüksek olduğunu bulduk; ancak regresyon analizimizde yüksek NLR'nun postoperatif hipokalsemi için anlamlı bir prediktif risk faktörü olmadığı gösterildi. Bildiğimiz kadarıyla bu, PHPT'li hastalarda hemogramdan türetilen inflamatuar belirteçler ile postoperatif hipokalsemi gelişimi ve preoperatif nefrolitiazis varlığı gibi klinik parametreler arasındaki ilişkiyi araştıran ilk çalışmadır.

Keywords

• Hiperparatiroidizm
• Hipokalsemi
• Nötrofiller
• Lenfositler
• Trombositler

The Relationship Between Hematological Inflammatory Markers and Postoperative Hypocalcemia in Patients with Primary Hyperparathyroidism

Abstract

Objective: Primary hyperparathyroidism (PHPT) is a common endocrine disease that is characterized by hypercalcemia and commonly associated with parathyroid adenoma (PTA). Hypocalcemia is a common postoperative complication in patients with PHPT. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inexpensive hematological inflammatory markers. We aimed to investigate the potential predictive risk factors, including the hemogram-derived inflammatory markers for early postoperative hypocalcemia in patients with PHPT. Material and Method: Patients diagnosed with PHPT, underwent parathyroidectomy and histopathologically shown to be caused by a single PTA were included. Results: NLR was significantly correlated with parathormone (PTH), while PLR was related considerably with only NLR. A significant positive correlation was shown between gland weight, volume, calcium (Ca), and PTH levels. A significant correlation of postoperative hypocalcemia with age, preoperative Ca, PTH, and NLR was also demonstrated. Conclusion: We found that NLR was significantly higher in patients with PHPT who developed postoperative hypocalcemia; however, our regression analysis did not find elevated NLR as a significant predictive risk factor for postoperative hypocalcemia. To the best of our knowledge, this is the first study investigating the relationship between hemogram-derived inflammatory markers and clinical parameters, such as the development of postoperative hypocalcemia and preoperative nephrolithiasis, in patients with PHPT. Keywords: Hyperparathyroidism, Hypocalcemia, Neutrophils, Lymphocytes, Platelets

Keywords

• Hyperparathyroidism
• Hypocalcemia
• Neutrophils
• Lymphocytes
• Platelets

References

1. 1. Williams BA, Trites JRB, Taylor SM, Bullock MJ, Hart RD. Surgical management of primary hyperparathyroidism in Canada. J Otolaryngol - Head Neck Surg 2014;43.
2. 2. Muñoz-Torres M, García-Martín A. Primary hyperparathyroidism. Med Clin (Barc) 2018;150(6):226–32.
3. 3. Singh Ospina NM, Rodriguez-Gutierrez R, Maraka S, Espinosa de Ycaza AE, Jasim S, Castaneda-Guarderas A, et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: A systematic review and meta-analysis. World J Surg 2016;40(10):2359–77.
4. 4. Mittendorf EA, Merlino JI, McHenry CR. Post-parathyroidectomy hypocalcemia: Incidence, risk factors, and management. Am Surg 2004;70(2):114–9.
5. 5. Crea N, Pata G, Casella C, Cappelli C, Salerni B. Predictive factors for postoperative severe hypocalcemia after parathyroidectomy for primary hyperparathyroidism. Am Surg 2012;78(3):352–8.
6. 6. Vasher M, Goodman A, Politz D, Norman J. Postoperative calcium requirements in 6,000 patients undergoing outpatient parathyroidectomy: Easily avoiding symptomatic hypocalcemia. J Am Coll Surg 2010;211(1):49–54.
7. 7. Phimphilai M, Inya S, Manosroi W. A predictive risk score to diagnose hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism: A 22-year retrospective cohort study. Sci Rep 2022;12(1).
8. 8. Yang PS, Liu CL, Liu TP, Chen HH, Wu CJ, Cheng SP. Parathyroidectomy decreases neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. J Surg Res 2018;224:169–75.

9. 9. Kaya C, Tam AA, Dirikoç A, Kılıçyazgan A, Kılıç M, Türkölmez Ş, et al. Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively? Arch Endocrinol Metab 2016;60(5):465–71.
10. 10. Zahorec R. Neutrophil-to-lymphocyte ratio, past, present, and future perspectives. Bratislava Med J 2021;122(7):474–88.
11. 11. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 2019;39(4):345–57.
12. 12. Lam HB, Yang PS, Chien MN, Lee JJ, Chao LF, Cheng SP. Association between neutrophil-to-lymphocyte ratio and parathyroid hormone in patients with primary hyperparathyroidism. Arch Med Sci 2019;15(4):880–6.
13. 13. Cheng SP, Liu CL, Liu TP, Hsu YC, Lee JJ. Association between parathyroid hormone levels and inflammatory markers among US adults. Mediators Inflamm 2014;2014.
14. 14. Lind L, Carlstedt F, Rastad J, Stiernström H, Stridsberg M, Ljunggren Ö, et al. Hypocalcemia and parathyroid hormone secretion in critically ill patients. Crit Care Med 2000;28(1):93–9.
15. 15. Verheyen N, Meinitzer A, Grübler MR, Ablasser K, Kolesnik E, Fahrleitner-Pammer A, et al. Low-grade inflammation and tryptophan-kynurenine pathway activation are associated with adverse cardiac remodeling in primary hyperparathyroidism: The EPATH trial. Clin Chem Lab Med 2017;55(7):1034–42.
16. 16. Toraman A, Aras F, Hekimsoy Z, Kursat S. Is there a relationship between parathyroid hormone and neutrophil-lymphocyte or platelet lymphocyte ratio? Acta Endocrinol (Copenh) 2019;15(1):96–101.
17. 17. Zeren S, Yaylak F, Ozbay I, Bayhan Z. Relationship between the neutrophil to lymphocyte ratio and parathyroid adenoma size in patients with primary hyperparathyroidism. Int Surg 2015;100(7–8):1185–9.
18. 18. Alakuş H, Göksu M. Does Parathyroidectomy affect the neutrophil/lymphocyte ratio, a systemic inflammatory marker? Cureus 202;13(3).
19. 19. Liu C, Tang L, Goel P, Chambers T, Kokot N, Sinha U, et al. A Practical mathematic method to predict and manage hypocalcemia after parathyroidectomy and thyroidectomy. Ann Otol Rhinol Laryngol 2020;129(1):70–7.