Determinants of survival in patients with calciphylaxis: A multivariate analysis
Accepted 24 September 2009.
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).
Conclusion
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.
Department of Surgery, University of Iowa Hospitals, Iowa City, IA
Reprint requests: Geeta Lal, MD, MSc, Assistant Professor of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 4641 JCP, Iowa City, IA 52242.
ABSTRACT