[Pubmed] Predictive factors for postoperative myasthenic crisis in patients with myasthenia gravis

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Interdiscip Cardiovasc Thorac Surg. 2023 Feb 21:ivad040. doi: 10.1093/icvts/ivad040. Online ahead of print.

ABSTRACT

OBJECTIVES: Thymectomy plays an important role in the comprehensive treatment of myasthenia gravis (MG). The present study aimed to investigate the risk factors for postoperative myasthenic crisis (POMC) in these patients and then establish a predicting model based on preoperatively available indicators.

METHODS: The clinical records of 177 consecutive patients with MG who received extended thymectomy between January 2018 and September 2022 in our department were retrospectively reviewed. Patients were divided into two groups according to whether they developed POMC and needed ventilation support for more than 24 hours. Univariate and multivariate regression analyses were conducted to identify the independent risk factors of POMC. Then a nomogram was constructed to intuitively show the results. Finally, the calibration curve and bootstrap resampling were used to evaluate its performance.

RESULTS: POMC occurred in 42 (23.7%) patients. By multivariate analysis, body mass index (BMI) (p = 0.029), Osserman classification (p = 0.015), percentage of predicted forced vital capacity (FVC, pred%) (p = 0.044), percentage of predicted forced expiratory volume in the first second (FEV1, pred%) (p = 0.043) and albumin to globulin ratio (AGR) (p = 0.009) were identified as independent risk factors and entered into the nomogram. The calibration curve showed good concordance between the predicted and actual probability of prolonged ventilation.

CONCLUSIONS: Our model is a valuable tool for predicting POMC in MG patients. For those high-risk patients, appropriate preoperative treatment is necessary to improve the symptoms and greater attention to postoperative complications is needed.

PMID:36808486 | DOI:10.1093/icvts/ivad040


Source: https://pubmed.ncbi.nlm.nih.gov/3680848 ... t6+86293ac