口腔癌患者术后低钾血症预测模型的构建及验证

Construction and verification of prediction model for postoperative hypokalemia in patients with oral cancer

目的探究影响口腔癌患者术后发生低钾血症的危险因素,为术后低钾血症的防控提供依据。方法纳入2022年1月—2022年8月在四川大学华西口腔医院头颈肿瘤外科的366例口腔癌手术患者,采用单因素和多因素分析确定术后低钾血症的危险因素,使用受试者工作特征(receiver operation characteristic,ROC)曲线量化因素的有效性,开发口腔癌患者术后低钾血症危险因素列线图并验证。结果共有224例(61.20%)患者出现术后低钾血症,术后第4天血钾水平最低(3.50±0.35)mmol/L,低钾血症发生率最高(54.68%)。将单因素分析中P<0.05的变量经ROC曲线量化后进行多因素Logistic回归分析,结果显示:术前血钾<3.87 mmol/L(P=0.008)、术前血钙<2.31 mmol/L(P=0.033)、术前预后营养指数(PNI)<49.16(P=0.032)、术后引流量>264.25 mL(P=0.002)与术后低钾血症独立相关,将上述变量构建成术后低钾血症发生风险列线图并进行验证,具有良好的拟合优度。结论术前血钾<3.87 mmol/L,术前血钙<2.31 mmol/L,术前PNI<49.16,术后引流量>264.25 mL是口腔癌患者术后低钾血症的独立危险因素。临床应重视以上高风险患者的管理,尽早进行预防性补钾以减少低钾血症的发生。

Objective This study aimed to explore the risk factors of postoperative hypokalemia in patients with oral cancer and to provide a basis for preventing and controlling postoperative hypokalemia.Methods We included 366 patients undergoing oral cancer surgery in the Department of Head and Neck Oncology,West China Hospital of Stomatology,Sichuan University from January 2022 to August 2022.Univariate and multivariate analyses were used to determine the risk factors of postoperative hypokalemia.The receiver operation characteristic(ROC)curve was used to quantify the effectiveness of the factors.A nomogram of the risk factors for postoperative hypokalemia in oral cancer patients was developed and validated.Results A total of 224 patients(61.20%)had postoperative hypokalemia,the lowest serum potassium level(3.50±0.35)mmol/L on the 4th day after surgery,and the highest incidence of hypokalemia(54.68%).Variables with P<0.05 in the univariate analysis were quantified by ROC curve followed by multivariate logistic regression analysis.Results showed an independent correlation with postoperative hypokalemia as follows:preoperative serum potassium<3.87 mmol/L(P=0.008),preoperative serum calcium<2.31 mmol/L(P=0.033),preoperative PNI<49.16(P=0.032),postoperative drainage volume>264.25 mL(P=0.002).The above variables were constructed into a postoperative hypokalemia risk nomogram and verified,and a good degree of fit was found.Conclusion The independent risk factors for postoperative hypokalemia in patients with oral cancer were as follows:preoperative serum potassium<3.87 mmol/L,preoperative serum calcium<2.31 mmol/L,preoperative PNI<49.16,and postoperative drainage volume>264.25 mL.Clinical attention should be paid to managing the above high-risk patients.Preventive potassium supplementation should be performed as soon as possible to reduce hypokalemia occurrence.