Determinants of survival in patients with calciphylaxis: a multivariate analysis.
BACKGROUND
Our study aims to assess the factors affecting survival in patients with calciphylaxis.


METHODS
We identified 26 patients with biopsy-proven calciphylaxis treated between 1995 and 2007. Clinical and follow-up data were obtained from medical records. Cox proportional hazards models were used to assess the factors affecting survival.


RESULTS
The study group consisted of 23 women and 3 men with a mean age of 56.4 +/- 12.9 years. All patients had multiple comorbidities/risk factors including coronary artery disease (58%), diabetes mellitus (58%), and peripheral vascular disease (23%). Mean laboratory values were: calcium, 9.0 mg/dL (range, 6.8-11.6); albumin, 2.8 mg/dL; phosphate, 4.5 mg/dL (range, 2.5-7.5); Ca *phosphate, 35.9; and parathyroid hormone, 320.9 pg/mL (range, 4.6-2,419). Parathyroidectomy was performed in 9 of 26 patients (35%). Of our patients, 19% underwent revascularization procedures and 58% underwent debridement. In multivariate analyses, factors associated with poor survival were female gender ( P = .01), increased weight ( P = .01), and need for vascular procedures ( P = .06). Improved survival was associated with operative debridement ( P = .01). Parathyroidectomy alone did not emerge as a determinant of patient survival, although there was a trend to improved survival when debridement and parathyroidectomy were combined ( P = .09).


CONCLUSIONS
Rather than a single intervention such as parathyroidectomy, a multidisciplinary approach involving early diagnosis, aggressive medical management, operative debridement, and parathyroidectomy may improve survival in calciphylaxis.
Lal
Geeta
G
Department of Surgery, University of Iowa Hospitals, Iowa City, IA 52242, USA. Geeta-lal@uiowa.edu
Nowell
Andrew G
AG
Liao
Junlin
J
Sugg
Sonia L
SL
Weigel
Ronald J
RJ
Howe
James R
JR
D000328:Adult; D000368:Aged; D002115:Calciphylaxis / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000601:surgery; D002118:Calcium / Q000097:blood; D003324:Coronary Artery Disease / Q000150:complications; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D016491:Peripheral Vascular Diseases / Q000150:complications; D010710:Phosphates / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors
D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium