Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Hypokalemia | Research

Prediction of postoperative hypokalemia in patients with oral cancer undergoing en bloc cancer resection: a retrospective cohort study

Authors: Qilin Bao, Lei Song, Liyuan Ma, Meng Wang, Zhaohuan Hou, Jie Lin, Chunjie Li

Published in: BMC Oral Health | Issue 1/2023

Login to get access

Abstract

Background

The factors associated with postoperative hypokalemia in patients with oral cancer remain unclear. We determined the preoperative factors associated with postoperative hypokalemia in patients with oral cancer following en bloc cancer resection and established a nomogram for postoperative hypokalemia prediction.

Methods

Data from 381 patients with oral cancer who underwent en bloc cancer resection were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the risk factors for postoperative hypokalemia. We used receiver operating characteristic (ROC) curves to quantify the factors’ effectiveness. A nomogram was created to show each predictor’s relative weight and the likelihood of postoperative hypokalemia development. The multinomial regression model’s effectiveness was also evaluated.

Results

Preoperative factors, including sex, preoperative serum potassium level, and preoperative platelet-to-lymphocyte ratio (PLR), were significantly associated with postoperative hypokalemia. Based on the ROC curve, the preoperative serum potassium and PLR cut-off levels were 3.98 mmol/L and 117, respectively. Further multivariate analysis indicated that female sex, preoperative serum potassium level < 3.98 mmol/L, and preoperative PLR ≥ 117 were independently associated with postoperative hypokalemia. We constructed a predictive nomogram with all these factors for the risk of postoperative hypokalemia with good discrimination and internal validation.

Conclusions

The predictive nomogram for postoperative hypokalemia risk constructed with these factors had good discrimination and internal validation. The developed nomogram will add value to these independent risk factors that can be identified at admission in order to predict postoperative hypokalemia.
Literature
1.
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33.CrossRefPubMed
2.
Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, et al. Guidelines for the surgical management of oral cancer: Korean society of thyroid-head and neck surgery. Clin Exp Otorhinolaryngol. 2019;12(2):107–44.PubMedPubMedCentral
3.
Roh JL, Kim MR, Choi SH, Lee JH, Cho KJ, Nam SY, Kim SY. Can patients with head and neck cancers invading carotid artery gain survival benefit from surgery? Acta Otolaryngol. 2008;128(12):1370–4.PubMed
4.
Santilli M, Addazio G, Rexhepi I, Sinjari B, Filippini A. Multiple free flap reconstruction of a complex intraoral defect after squamous cell carcinoma excision: a case report. Medicina (Kaunas). 2021;58(1):54.PubMed
5.
Kain JJ, Birkeland AC, Udayakumar N, Morlandt AB, Stevens TM, Carroll WR, Rosenthal EL, Warram JM. Surgical margins in oral cavity squamous cell carcinoma: current practices and future directions. Laryngoscope. 2020;130(1):128–38.PubMed
6.
Wang C, Fu G, Liu F, Liu L, Cao M. Perioperative risk factors that predict complications of radial forearm free flaps in oral and maxillofacial reconstruction. Br J Oral Maxillofac Surg. 2018;56(6):514–9.PubMed
7.
Greco A, Rabito G, Pironi M, Bissig M, Parlato S, Andreocchi L, Bianchi G, Poretti Guigli M, Llamas M, Monotti R, et al. Hypokalaemia in hospitalised patients. Swiss Med Wkly. 2016;146:w14320.PubMed
8.
Mattsson N, Nielsen OW, Johnson L, Prescott E, Schnohr P, Jensen GB, Kober L, Sajadieh A. Prognostic impact of mild hypokalemia in terms of death and stroke in the general population-a prospective population study. Am J Med. 2018;131(3):318 e319.
9.
Khan S, Khan SU. Adverse drug event of hypokalaemia-induced cardiotoxicity secondary to the use of laxatives: a systematic review of case reports. J Clin Pharm Ther. 2020;45(5):927–36.PubMed
10.
Schaefer TJ, Wolford RW. Disorders of potassium. Emerg Med Clin North Am. 2005;23(3):723–47 viii-ix.PubMed
11.
Alfonzo AV, Isles C, Geddes C, Deighan C. Potassium disorders–clinical spectrum and emergency management. Resuscitation. 2006;70(1):10–25.PubMed
12.
Lu G, Xu L, Zhong Y, Shi P, Shen X. Significance of serum potassium level monitoring during the course of post-operative rehabilitation in patients with hypokalemia. World J Surg. 2014;38(4):790–4.PubMed
13.
Arora P, Pourafkari L, Visnjevac O, Anand EJ, Porhomayon J, Nader ND. Preoperative serum potassium predicts the clinical outcome after non-cardiac surgery. Clin Chem Lab Med. 2017;55(1):145–53.PubMed
14.
Jiang N, Deng JY, Ding XW, Ke B, Liu N, Zhang RP, Liang H. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol. 2014;20(30):10537–44.PubMedPubMedCentral
15.
Walzik D, Joisten N, Zacher J, Zimmer P. Transferring clinically established immune inflammation markers into exercise physiology: focus on neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index. Eur J Appl Physiol. 2021;121(7):1803–14.PubMedPubMedCentral
16.
Concato J, Feinstein AR, Holford TR. The risk of determining risk with multivariable models. Ann Intern Med. 1993;118(3):201–10.PubMed
17.
Paice BJ, Paterson KR, Onyanga-Omara F. Record linkage study of hypokalaemia in hospitalized patients. Postgrad Med J. 1986;62(725):187–91.PubMedPubMedCentral
18.
Riley RD, Ensor J, Snell KIE, Harrell FE Jr, Martin GP, Reitsma JB, Moons KGM, Collins G, van Smeden M. Calculating the sample size required for developing a clinical prediction model. BMJ. 2020;368:m441.PubMed
19.
Riley RD, Debray TPA, Collins GS, Archer L, Ensor J, van Smeden M, Snell KIE. Minimum sample size for external validation of a clinical prediction model with a binary outcome. Stat Med. 2021;40(19):4230–51.PubMed
20.
Chu T, Wu Z, Xu A. Association between preoperative hypokalemia and postoperative complications in elderly patients: a retrospective study. BMC Geriatr. 2022;22(1):743.PubMedPubMedCentral
21.
Lin SH. A practical and pathophysiologic approach to hypokalemi. Hong Kong J Nephrol. 2008;10(1):14–26.
22.
Viera AJ, Wouk N. Potassium disorders: hypokalemia and hyperkalemia. Am Fam Physician. 2015;92(6):487–95.PubMed
23.
Bao X, Liu F, Lin J, Chen Q, Chen L, Chen F, Wang J, Qiu Y, Shi B, Pan L, et al. Nutritional assessment and prognosis of oral cancer patients: a large-scale prospective study. BMC Cancer. 2020;20(1):146.PubMedPubMedCentral
24.
Liu SA, Tsai WC, Wong YK, Lin JC, Poon CK, Chao SY, Hsiao YL, Chan MY, Cheng CS, Wang CC, et al. Nutritional factors and survival of patients with oral cancer. Head Neck. 2006;28(11):998–1007.PubMed
25.
De Ridder D, Belle FN, Marques-Vidal P, Ponte B, Bochud M, Stringhini S, Joost S, Guessous I. Geospatial analysis of sodium and potassium intake: a Swiss population-based study. Nutrients. 2021;13(6):1798.PubMedPubMedCentral
26.
Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, Compher C, Correia I, Higashiguchi T, Holst M, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49–64.PubMed
27.
Rastegar A, Soleimani M. Hypokalaemia and hyperkalaemia. Postgrad Med J. 2001;77(914):759–64 Rastergar A [corrected to Rastegar A].PubMed
28.
Khan LU, Ahmed J, Khan S, Macfie J. Refeeding syndrome: a literature review. Gastroenterol Res Pract. 2011;2011:410971.PubMed
29.
Grasso S, Ferro Y, Migliaccio V, Mazza E, Rotundo S, Pujia A, Montalcini T. Hypokalemia during the early phase of refeeding in patients with cancer. Clinics. 2013;68(11):1413–5.PubMedPubMedCentral
30.
Cohn JN, Kowey PR, Whelton PK, et al. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on potassium in clinical practice. Arch Intern Med. 2000;160(16):2429–36.PubMed
31.
Krogager ML, Torp-Pedersen C, Mortensen RN, Kober L, Gislason G, Sogaard P, Aasbjerg K. Short-term mortality risk of serum potassium levels in hypertension: a retrospective analysis of nationwide registry data. Eur Heart J. 2017;38(2):104–12.PubMed
32.
Leier CV, Cas LD, Metra M. Clinical relevance and management of the major electrolyte abnormalities in congestive heart failure: hyponatremia, hypokalemia, and hypomagnesemia. Am Heart J. 1994;128(3):564–74.PubMed
33.
Xu Q, Xu F, Fan L, Xiong L, Li H, Cao S, Lin X, Zheng Z, Yu X, Mao H. Serum potassium levels and its variability in incident peritoneal dialysis patients: associations with mortality. PLoS One. 2014;9(1):e86750.PubMedPubMedCentral
34.
Jensen GL, et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. Clin Nutr. 2010;29:151–3.PubMed
35.
36.
Charles KA, Harris BD, Haddad CR, Clarke SJ, Guminski A, Stevens M, Dodds T, Gill AJ, Back M, Veivers D, et al. Systemic inflammation is an independent predictive marker of clinical outcomes in mucosal squamous cell carcinoma of the head and neck in oropharyngeal and non-oropharyngeal patients. BMC Cancer. 2016;16:124.PubMedPubMedCentral
37.
Tang J-N, Goyal H, Yu S, Luo H. Prognostic value of systemic immune-inflammation index (SII) in cancers: a systematic review and meta-analysis. J Lab Precis Med. 2018;3:29–29.
38.
Zhang F, Gong W. Prognostic value of the platelet-to-lymphocyte ratio in patients with melanoma: a meta-analysis. Front Oncol. 2020;10:1116.PubMedPubMedCentral
39.
Zhou X, Du Y, Huang Z, Xu J, Qiu T, Wang J, Wang T, Zhu W, Liu P. Prognostic value of PLR in various cancers: a meta-analysis. PLoS One. 2014;9(6):e101119.PubMedPubMedCentral
40.
Thurlow, Ozevlat, Jones. Establishing a practical blood platelet threshold to avoid reporting spurious potassium results due to thrombocytosis. Ann Clin Biochem. 2005;42(3):196–9.PubMed
41.
42.
Finch CE. Inflammatory exposure and historical changes in human life-spans. Science. 2004;305(5691):P.1736-1739.
43.
Krabbe KS, Pedersen M, Bruunsgaard H. Inflammatory mediators in the elderly. Exp Gerontol. 2004;39(5):687–99.PubMed
44.
Hawkins RC. Gender and age as risk factors for hypokalemia and hyperkalemia in a multiethnic Asian population. Clin Chim Acta. 2003;331(1–2):171–2.PubMed
45.
Liamis G, Rodenburg EM, Hofman A, Zietse R, Stricker BH, Hoorn EJ. Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med. 2013;126(3):256–63.PubMed
46.
Jensen HK, Brabrand M, Vinholt PJ, Hallas J, Lassen AT. Hypokalemia in acute medical patients: risk factors and prognosis. Am J Med. 2015;128(1):60–7 e61.PubMed
47.
Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, Vickers AJ, Ransohoff DF, Collins GS. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015;162(1):W1-73.PubMed
48.
Balachandran VP, Gonen M, Smith JJ, DeMatteo RP. Nomograms in oncology: more than meets the eye. Lancet Oncol. 2015;16(4):e173–80.PubMedPubMedCentral
49.
Krogager ML, Sogaard P, Torp-Pedersen C, Boggild H, Lee CJ, Bonde A, Thomassen JQ, Gislason G, Pareek M, Kragholm K. Impact of plasma potassium normalization on short-term mortality in patients with hypertension and hypokalemia or low normal potassium. BMC Cardiovasc Disord. 2020;20(1):386.PubMedPubMedCentral
50.
Schroeder EB, Adams JL, Chonchol M, Nichols GA, O’Connor PJ, Powers JD, Schmittdiel JA, Shetterly SM, Steiner JF. Predictors of hyperkalemia and hypokalemia in individuals with diabetes: a classification and regression tree analysis. J Gen Intern Med. 2020;35(8):2321–8.PubMedPubMedCentral
Metadata
Title
Prediction of postoperative hypokalemia in patients with oral cancer undergoing en bloc cancer resection: a retrospective cohort study
Authors
Qilin Bao
Lei Song
Liyuan Ma
Meng Wang
Zhaohuan Hou
Jie Lin
Chunjie Li
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-03371-7

Other articles of this Issue 1/2023

BMC Oral Health 1/2023 Go to the issue

Research

Oral health profile and periodontal diseases awareness and knowledge among the jordanian population: a cross-sectional study

Research

Three-dimensional relationships between condylar volume and dentoskeletal characteristics in Class II hyperdivergent female adults

Research

The impact of periodontal disease on the clinical outcomes of COVID-19: A systematic review and meta-analysis

Research

Accurate mandibular canal segmentation of dental CBCT using a two-stage 3D-UNet based segmentation framework

Research

The oral health-related quality of life for individuals with fetal alcohol spectrum disorder – a cross-sectional study

Research

Prediction of orthognathic surgery plan from 3D cephalometric analysis via deep learning