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

doi:10.7518/hxkq.2024.2024130

Abstract

Abstract:

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.

Key words: oral cancer, hypokalemia, prognostic nutritional index, influencing factor, nomogram

CLC Number:

R739.8

Wang Guangman, Bi Xiaoqin, Tang Xiaoxue. Construction and verification of prediction model for postoperative hypokalemia in patients with oral cancer[J]. West China Journal of Stomatology, 2024, 42(6): 778-786.

Figures/Tables 7

Fig 1

Tab 1

Model training set and validation set baseline characteristics

变量		训练集（n=256）	验证集（n=110）	t/Z/x²值	P值
年龄/岁		59.00（52.00，69.00）	62.00（53.75，72.25）	-1.617	0.106
性别/［n（%）］	女	103（40.23）	33（30.00）	3.451	0.063
	男	153（59.77）	77（70.00）
BMI/（kg/m²）		23.05（20.89，25.38）	23.31（20.54，25.57）	-0.157	0.875
术前红细胞计数/（×10¹²/L）		4.48（4.12，4.85）	4.56（4.05，4.88）	-0.320	0.749
术前PLR/		133.41（105.79，171.23）	128.66（97.53，168.20）	-0.696	0.487
术前PNI/		49.70（47.74，52.63）	50.02（47.38，53.43）	-0.426	0.670
术前血钙/（mmol/L）		2.32（2.26，2.41）	2.34（2.29，2.38）	-1.106	0.269
术前血钾/（mmol/L）		3.98±0.34	4.01±0.33	-0.880	0.379
手术时长/min		263.50（170.00，335.25）	283.00（148.75，380.00）	-0.949	0.343
术中补液量/mL		2 000.00（1 262.50，2 850.00）	2 325.00（1 450.00，3 212.50）	-1.385	0.166
术中失血量/mL		300.00（200.00，400.00）	325.00（187.50，450.00）	-0.350	0.726
术中尿量/mL		450.00（150.00，700.00）	450.00（200.00，700.00）	-0.778	0.436
术后引流量/mL		357.25（79.25，607.00）	382.00（140.00，590.00）	-0.733	0.463
术后禁食时长/h		17.67±2.64	17.24±2.80	1.381	0.168
肿瘤部位/［n（%）］	舌	93（36.33）	48（43.64）	7.503	0.186
	颊	61（23.83）	23（20.91）
	口底	24（9.38）	16（6.25）
	腭	31（12.11）	8（3.13）
	牙龈	25（9.77）	5（4.55）
	其他	22（8.59）	10（9.09）
肿瘤大小/［n（%）］	T1、T2	129（50.39）	46（41.82）	2.266	0.132
	T3、T4	127（49.61）	64（58.18）
淋巴结转移/［n（%）］	否	162（63.28）	76（69.09）	1.142	0.285
	是	94（36.72）	34（30.91）
高血压史/［n（%）］	否	184（71.88）	68（61.82）	3.629	0.057
	是	72（28.13）	42（38.18）
糖尿病史/［n（%）］	否	235（91.80）	99（90.00）	0.311	0.577
	是	21（8.20）	11（10.00）
是否输血/［n（%）］	否	253（98.83）	106（96.36）	1.351	0.245
	是	3（1.17）	4（3.64）
有无呕吐反应/［n（%）］	否	249（97.27）	107（97.27）	0.000	0.997
	是	7（2.73）	3（2.73）
术前进食情况/［n（%）］	普食	254（99.22）	109（99.09）	2.584	0.364
	软食	0（0.00）	1（0.91）
	流食	2（0.78）	0（0.00）
是否使用胰岛素/［n（%）］	否	237（92.58）	100（90.91）	0.294	0.588
	是	19（7.42）	10（9.09）
是否使用利尿类降压药/［n（%）］	否	255（99.61）	110（100.00）	0.431	0.512
	是	1（0.39）	0（0.00）

Tab 1

Tab 2

Univariate analysis of hypokalemia in training set

变量		低钾组（n=164）	正常组（n=92）	t/Z/x²值	P值
年龄/岁		59.00（52.25，69.00）	58.00（51.00，69.00）	-0.552	0.581
性别/［n（%）］	女	72（43.90）	31（33.70）	2.553	0.110
	男	92（56.10）	61（66.30）
BMI/（kg/m²）		23.05（20.72，24.96）	23.08（21.11，25.91）	-0.804	0.421
术前红细胞计数/（×10¹²/L）		4.47（4.11，4.79）	4.59（4.12，5.00）	-0.956	0.339
术前PLR/		138.17（109.80，176.49）	121.72（100.31，165.10）	-1.870	0.061
术前PNI/		49.01（47.24，51.92）	51.08（48.83，53.76）	-3.642	<0.001^**
术前血钙/（mmol/L）		2.29（2.25，2.40）	2.35（2.29，2.42）	-3.153	0.002^*
术前血钾/（mmol/L）		3.91±0.32	4.09±0.35	4.176	<0.001^**
手术时长/min		265.00（185.00，347.50）	242.50（162.75，323.75）	-0.619	0.536
术中补液量/mL		2 025.00（1 512.50，2 750.00）	1 950.00（962.50，3 000.00）	-0.969	0.333
术中失血量/mL		300.00（250.00，350.00）	275.00（100.00，450.00）	-0.741	0.459
术中尿量/mL		500.00（50.00，700.00）	400.00（0.00，600.00）	-1.914	0.056
术后引流量/mL		405.50（141.13，657.75）	257.50（0.00，480.50）	-2.759	0.006^*
术后禁食时长/h		17.68±2.68	17.63±2.58	-0.156	0.876
肿瘤部位［n（%）］	舌	51（31.10）	42（45.65）	10.577	0.060
	颊	49（29.88）	12（13.04）
	口底	15（9.15）	9（9.78）
	腭	19（11.59）	12（13.04）
	牙龈	16（9.76）	9（9.78）
	其他	14（8.54）	8（8.70）
肿瘤大小［n（%）］	T1、T2	76（46.34）	53（57.61）	2.993	0.084
	T3、T4	88（53.66）	39（42.39）
淋巴结转移［n（%）］	否	102（62.20）	60（65.22）	0.232	0.630
	是	62（37.80）	32（34.78）
高血压史［n（%）］	否	112（68.29）	72（78.26）	2.897	0.089
	是	52（31.71）	20（21.74）
糖尿病史［n（%）］	否	151（92.07）	84（91.30）	0.046	0.830
	是	13（7.93）	8（8.70）
是否输血［n（%）］	否	162（98.78）	91（98.91）	0.009	0.925
	是	2（1.22）	1（1.09）
有无呕吐反应［n（%）］	否	159（96.95）	90（97.83）	0.170	0.680
	是	5（3.05）	2（2.17）
术前进食情况［n（%）］	普食	162（98.78）	92（100.00）	0.105	0.538
	流食	2（1.22）	0（0.00）
是否使用胰岛素［n（%）］	否	152（92.68）	85（92.39）	0.007	0.932
	是	12（7.32）	7（7.61）
是否使用利尿类降压药［n（%）］	否	163（99.39）	92（100.00）	0.563	0.453
	是	1（0.61）	0（0.00）

Tab 2

Fig 2

Tab 3

Fig 3

Fig 4

References 35

1	Siegel R L, Giaquinto A N, Jemal A. Cancer statistics, 2024[J]. CA Cancer J Clin, 2024, 74(1): 12-49.
2	Joo YH, Joo YH, Cho JK, et al. Guidelines for the surgical management of oral cancer: Korean society of thyroid-head and neck surgery[J]. Clin Exp Otorhinolaryngol, 2019, 12(2): 107-144.
3	Santilli M, D’Addazio G, Rexhepi I, et al. Multiple free flap reconstruction of a complex intraoral defect after squamous cell carcinoma excision: a case report[J]. Medicina(Kaunas), 2021, 58(1): 54.
4	卢倩, 郭柳媚, 毕小琴. 口腔癌患者术后吞咽障碍危险因素的系统评价[J]. 华西口腔医学杂志, 2022, 40(3): 328-334.
	Lu Q, Guo LM, Bi XQ. Systematic review of risk factors of postoperative dysphagia in patients with oral cancer[J]. West China J Stomatol, 2022, 40(3): 328-334.
5	白露, 邹聚芬, 毕小琴, 等. 口腔癌患者围手术期相关症状及症状群变化的纵向研究[J]. 重庆医学, 2023, 52(13): 1974-1979.
	Bai L, Zhou JF, Bi XQ, et al. Longitudinal study on changes of perioperative related symptoms and symptom cluster in patients with oral cancer[J]. Chongqing Med J, 2023, 52(13): 1974-1979.
6	Alfano G, Ferrari A, Fontana F, et al. Hypokalemia in patients with COVID-19[J]. Clin Exp Nephrol, 2021, 25(4): 401-409.
7	王宁, 石玉博, 宋建利, 等. 非心脏手术患者围手术期钾离子紊乱的病理生理学及其治疗和预防的研究进展[J]. 吉林大学学报(医学版), 2021, 47(5): 1314-1322.
	Wang N, Shi YB, Song JL, et al. Research progress in pathophysiology, treatment and prevention of perioperative potassium disturbance in non-cardiac surgery patients[J]. J Jilin Univ(Med Ed), 2021, 47(5): 1314-1322.
8	Arora P, Pourafkari L, Visnjevac O, et al. Preoperative serum potassium predicts the clinical outcome after non-cardiac surgery[J]. Clin Chem Lab Med, 2017, 55(1): 145-153.
9	Jensen HK, Brabrand M, Vinholt PJ, et al. Hypokalemia in acute medical patients: risk factors and prognosis[J]. Am J Med, 2015, 128(1): 60-67.e1.
10	王林, 王冉, 刘婷, 等. 非糖尿病老年患者术中血糖异常风险预测模型的构建及验证[J]. 中华护理杂志, 2023, 58(3): 318-324.
	Wang L, Wang R, Liu T, et al. Development of a risk prediction model for intraoperative abnormal blood glucose in elderly patients without diabetes[J]. Chin J Nurs, 2023, 58(3): 318-324.
11	Bao QL, Song L, Ma LY, et al. Prediction of postoperative hypokalemia in patients with oral cancer undergoing en bloc cancer resection: a retrospective cohort study[J]. BMC Oral Health, 2023, 23(1): 663.
12	Pan P, Zhang ZT, Zhang XF, et al. Postoperative pre-valence and risk factors for serum hypokalemia in patients with primary total joint arthroplasty[J]. Orthop Surg, 2024, 16(1): 72-77.
13	Zhao L, Shen X, Yang L, et al. Association of prognostic nutritional index with mortalities in American adult cancer survivors: a cohort study based on NHANES, 1999-2018[J]. Food Sci Nutr, 2024, 12(3): 1834-1846.
14	李晓松. 医学统计学(4版)[M]. 北京: 高等教育出版社, 2020: 218-219.
	Li XS. Medical statistics(4th ed)[M]. Beijing: Higher Education Press, 2020: 218-219.
15	Greco A, Rabito G, Pironi M, et al. Hypokalaemia in hos-pitalised patients[J]. Swiss Med Wkly, 2016, 146(2526): w14320. DOI:10.4414/smw.2016.14320 .
16	Zhang W, Zhang SX, Chen SF, et al. Development and validation of risk prediction model for refeeding syndrome in neurocritical patients[J]. Front Nutr, 2023, 10: 1083483.
17	Weir MR, Espaillat R. Clinical perspectives on the ra-tionale for potassium supplementation[J]. Postgrad Med, 2015, 127(5): 539-548.
18	赖展鸿, 张起帆, 钱建平, 等. 加速康复外科理念下肝切除术后水电解质紊乱的倾向性匹配回顾性分析[J]. 肝胆胰外科杂志, 2022, 34(3): 145-151.
	Lai ZH, Zhang QF, Qian JP, et al. Propensity score mat-ching and retrospective analysis of postoperative fluid management and electrolyte disorders after hepatectomy under the concept of enhanced recovery after surgery[J]. J Hepatopancreatobil Surg, 2022, 34(3): 145-151.
19	周冰琦, 牟弘毅, 李雪艳. 多学科联动智慧化管理在肝切除住院患者低钾血症管理中的应用效果[J]. 肝胆胰外科杂志, 2024, 36(7): 426-429.
	Zhou BQ, Mou HY, Li XY. Application of multi-disciplinary linkage intelligent management on hypokalemia in hospitalized patients with hepatectomy[J]. J Hepatopancreatobil Surg, 2024, 36(7): 426-429.
20	汤卫红, 徐翠荣, 孙云飞, 等. 不同溶媒稀释氯化钾口服液口感接受程度的效果观察[J]. 现代医学, 2022, 50(8): 1060-1063.
	Tang WH, Xu CR, Sun YF, et al. Effect of 10% potas-sium chloride injection diluted with different solvent on oral acceptance[J]. Modern Med J, 2022, 50(8): 1060-1063.
21	Krogager ML, Torp-Pedersen C, Mortensen RN, et al. Short-term mortality risk of serum potassium levels in hypertension: a retrospective analysis of nationwide registry data[J]. Eur Heart J, 2017, 38(2): 104-112.
22	Krogager ML, Sogaard P, Torp-Pedersen C, et al. Impact of plasma potassium normalization on short-term morta-lity in patients with hypertension and hypokalemia or low normal potassium[J]. BMC Cardiovasc Disord, 2020, 20(1): 386.
23	DeSalvo KB, Olson R, Casavale KO. Dietary guidelines for Americans[J]. JAMA, 2016, 315(5): 457-458.
24	Liu LL, Xie KH, Yin MM, et al. Serum potassium, albumin and vitamin B₁₂ as potential oxidative stress mar-kers of fungal peritonitis[J]. Ann Med, 2021, 53(1): 2132-2141.
25	Ray-Coquard I, Cropet C, van Glabbeke M, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas[J]. Cancer Res, 2009, 69(13): 5383-5391.
26	Walzik D, Joisten N, Zacher J, et al. Transferring cli-nically established immune inflammation markers into exercise physiology: focus on neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index[J]. Eur J Appl Physiol, 2021, 121(7): 1803-1814.
27	Gleeson M, Bishop NC, Stensel DJ, et al. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease[J]. Nat Rev Immunol, 2011, 11(9): 607-615.
28	Wischmeyer PE, Carli F, Evans DC, et al. American society for enhanced recovery and perioperative quality ini-tiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway[J]. Anesth Analg, 2018, 126(6): 1883-1895.
29	Bolshinsky V, Li MH, Ismail H, et al. Multimodal prehabilitation programs as a bundle of care in gastrointestinal cancer surgery: a systematic review[J]. Dis Colon Rectum, 2018, 61(1): 124-138.
30	Spahn DR. Hypocalcemia in trauma: frequent but frequently undetected and underestimated[J]. Crit Care Med, 2005, 33(9): 2124-2125.
31	Wray JP, Bridwell RE, Schauer SG, et al. The diamond of death: hypocalcemia in trauma and resuscitation[J]. Am J Emerg Med, 2021, 41: 104-109.
32	李幼生. 从加速康复外科到预康复——理念更新与临床实践模式转变[J]. 中国实用外科杂志, 2024, 44(2): 155-159.
	Li YS. From enhanced recovery after surgery to prehabilitation the new concepts and clinical practice[J]. Chin J Pract Surg, 2024, 44(2): 155-159.
33	李春洁, 韩波, 朱桂全. 口腔颌面部缺损游离皮瓣修复中血管吻合的技巧及关键点[J]. 华西口腔医学杂志, 2022, 40(3): 271-278.
	Li CJ, Han B, Zhu GQ. Vessel anastomosis in free flap reconstruction for oral and maxillofacial defects: techniques and key points[J]. West China J Stomatol, 2022, 40(3): 271-278.
34	王光满, 毕小琴. 口腔癌患者非计划再次手术的影响因素分析[J]. 重庆医学, 2024, 53(9): 1353-1359.
	Wang GM, Bi XQ. Analysis of influencing factors of unplanned reoperation in patients with oral cancer[J]. Chongqing Med J, 2024, 53(9): 1353-1359..
35	王天龙. 推动麻醉前预康复临床实践,实现围术期高质量发展[J]. 临床麻醉学杂志, 2024, 40(2): 117-118.
	Wang TL. Promote the clinical practice of pre-anesthesia pre-rehabilitation to achieve high-quality perioperative development[J]. J Clin Anesthesiol, 2024, 40(2): 117-118.

变量	B	SE	Wald	P值	OR（95% CI）	VIF
术前血钾<3.87 mmol/L	0.910	0.340	7.147	0.008	2.484（1.275~4.840）	1.298
术前血钙<2.31 mmol/L	0.688	0.322	4.554	0.033	1.989（1.058~3.741）	1.314
术前PNI<49.16	0.722	0.337	4.577	0.032	2.058（1.062~3.986）	1.474
术后引流量>264.25 mL	0.890	0.291	9.378	0.002	2.434（1.378~4.302）	1.004
常量	-0.781	0.267	8.557	0.003

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[8]	Qin Shuo, Li Chunmei, Li Ran, Hu Shuang, Li Guanghui, Sun Minglei. The prognostic value of preoperative peripheral blood inflammatory indicators for squamous cell carcinoma of tongue [J]. West China Journal of Stomatology, 2022, 40(3): 335-340.
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