Wen W, Krinsky S, Kroshinsky D, Durant O, He J, Seethapathy R, Hillien SAS, Mengesha B, Malhotra R, Chitalia V, Nazarian RM, Goverman J, Lyons KS, Nigwekar SU, et al.
Mayo Clinic proceedings. Innovations, quality & outcomes. Date of publication 2023 Jan 24;volume 7(1):81-92.
1. Mayo Clin Proc Innov Qual Outcomes. 2023 Jan 24;7(1):81-92. doi:
10.1016/j.mayocpiqo.2022.12.006. eCollection 2023 Feb.
Patient-Reported and Clinical Outcomes Among Patients With Calciphylaxis.
Wen W(1), Krinsky S(1), Kroshinsky D(2), Durant O(3), He J(4), Seethapathy R(1),
Hillien SAS(1), Mengesha B(1), Malhotra R(5)(6), Chitalia V(7)(8)(9), Nazarian
RM(10), Goverman J(11), Lyons KS(12), Nigwekar SU(1).
Author information:
(1)Division of Nephrology, Massachusetts General Hospital, Boston, MA.
(2)Department of Dermatology, Massachusetts General Hospital, Boston, MA.
(3)Bouvé College of Health Sciences, Northeastern University, Boston, MA.
(4)Lexington High School, Lexington, MA.
(5)Cardiovascular Research Center and the Cardiology Division of the Department
of Medicine, Massachusetts General Hospital, Boston, MA.
(6)Cardiovascular Research Center and the Cardiology Division of the Department
of Medicine, Harvard Medical School, Boston, MA.
(7)Renal Section, Department of Medicine, Boston University Medical Center,
Boston, MA.
(8)Veterans Affairs Boston Healthcare System, Boston, MA.
(9)Institute of Medical Engineering and Sciences, Massachusetts Institute of
Technology, Cambridge, MA.
(10)Department of Pathology, Massachusetts General Hospital, Boston, MA.
(11)Sumner Redstone Burn Center, Massachusetts General Hospital, Boston, MA.
(12)William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.
OBJECTIVE: To describe the pain intensity among hospitalized patients with
calciphylaxis, elucidate the factors associated with pain improvement, and
examine the link between pain improvement and clinical outcomes.
PATIENTS AND METHODS: Patients were identified from the Partners Research
Patient Data Registry and the Partners Calciphylaxis Registry and Biorepository
(Clinicaltrials.gov ID: NCT03032835). Those with calciphylaxis requiring
hospitalization for at least 14 consecutive days during the study period from
May 2016 through December 2021 were included. Pain intensity was assessed using
patient-reported pain scores on numerical rating scales from 0 to 10.
Associations between pain improvement and clinical outcomes, including lesion
improvement, amputation, and mortality, were examined using univariate and
multivariate regression models.
RESULTS: Our analysis included 111 patients (age, 58±14 years; men, 40%; on
maintenance dialysis, 79%). No significant improvement of pain intensity was
observed over the 14 days of hospitalization (mean difference, -0.71; P=.08).
However, among 49 (44.1%) patients who showed at least 1-point improvement in
the pain score, there was an association with surgical debridement during
hospitalization (odds ratio, 3.37; 95% CI, 1.17-9.67; P=.02). Hyperbaric oxygen
therapy was associated with pain improvement (odds ratio, 5.38; 95% CI,
1.14-25.50; P=.03) in patients on maintenance dialysis. Pain improvement was
associated with lower rates of subsequent amputation at 6 months of follow up
(6% vs 13%; P<.05) but did not predict lesion improvement or survival.
CONCLUSION: Pain control remains a challenge among hospitalized patients with
calciphylaxis. Surgical debridement and hyperbaric oxygen therapy may improve
pain intensity. Pain improvement predicted a lower risk of future amputation.
© 2023 The Authors.
DOI: 10.1016/j.mayocpiqo.2022.12.006
PMCID: PMC9880339
PMID: 36712824
