title: Diagnostic Accuracy Study of Intraoperative and Perioperative Serum Intact PTH Level for Successful Parathyroidectomy in 501 Secondary Hyperparathyroidism Patients.
abstract: Parathyroidectomy (PTX) is an effective treatment for severe secondary hyperparathyroidism (SHPT); however, persistent SHPT may occur because of supernumerary and ectopic parathyroids. Here a diagnostic accuracy study of intraoperative and perioperative serum intact parathyroid hormone (iPTH) was performed to predict successful surgery in 501 patients, who received total PTX + autotransplantation without thymectomy. Serum iPTH values before incision (io-iPTH0), 10 and 20 min after removing the last parathyroid (io-iPTH10, io-iPTH20), and the first and fourth day after PTX (D1-iPTH, D4-iPTH) were recoded. Patients whose serum iPTH was >50 pg/mL at the first postoperative week were followed up within six months. Successful PTX was defined if iPTH was <300 pg/mL, on the contrary, persistent SHPT was regarded. There were 86.4% patients underwent successful PTX, 9.8% remained as persistent SHPT and 3.8% were undetermined. Intraoperative serum iPTH demonstrated no significant differences in two subgroups with or without chronic hepatitis. Receiver operating characteristic (ROC) curves showed that >88.9% of io-iPTH20% could predict successful PTX (area under the curve [AUC] 0.909, sensitivity 78.6%, specificity 88.5%), thereby avoiding unnecessary exploration to reduce operative complications. D4-iPTH >147.4 pg/mL could predict persistent SHPT (AUC 0.998, sensitivity 100%, specificity 99.5%), so that medical intervention or reoperation start timely.
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Lina
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Changying
authors.initials: C
authors.lastname: Xing
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, 211166, People's Republic of China.
authors.forename: Chong
authors.initials: C
authors.lastname: Shen
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zeng
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Guang
authors.initials: G
authors.lastname: Yang
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Huijuan
authors.initials: H
authors.lastname: Mao
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Xiangbao
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Yiyao
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Chun
authors.initials: C
authors.lastname: Ouyang
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ge
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Caixia
authors.initials: C
authors.lastname: Yin
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Zha
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, People's Republic of China.
authors.forename: Ningning
authors.initials: N
authors.lastname: Wang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D059035:Perioperative Period; D012372:ROC Curve; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone