Risk Factors and Long-Term Survival Outcomes of Sagliker Syndrome After Parathyroidectomy in a Chinese Cohort

<h2>Abstract</h2><h3>Introduction</h3> Sagliker syndrome (SS) is a severe, disfiguring manifestation of refractory secondary hyperparathyroidism (SHPT). Although parathyroidectomy (PTX) corrects biochemical abnormalities, long-term outcomes after PTX in patients with SS remain uncertain. This study hypothesized that SS represents a high-risk phenotype associated with adverse long-term outcomes despite surgical intervention. <h3>Methods</h3> This single-center retrospective cohort study included 740 dialysis patients with severe refractory SHPT who underwent PTX. Patients were classified into SS (n = 70) and non-SS (n = 670) groups. Multivariable logistic regression identified factors associated with SS, while Cox models evaluated associations of SS with all-cause and cardiovascular disease (CVD) mortality. Sensitivity and subgroup analyses assessed robustness. <h3>Results</h3> The prevalence of SS was 9.5%. Independent factors associated with SS included longer dialysis vintage (OR = 1.21, <i>P</i> < 0.001), alkaline phosphatase > 315 U/L (OR = 4.14, <i>P</i> < 0.001), hypoalbuminemia (OR = 0.92, <i>P</i> = 0.013), cardiac valve calcification (OR = 2.11, <i>P</i> = 0.014), and abdominal aortic calcification (OR = 2.14, <i>P</i> = 0.016). Exploratory cephalometry in a small subset was consistent with prior SS reports. Exploratory post-PTX analyses suggested improved quality of life (n = 25), reduced bone pain (n = 45), and stabilization of height loss (n = 15) in patients with SS (all <i>P</i> < 0.05). Over a median follow-up of 81 months, SS was independently associated with higher all-cause mortality (HR 1.71, 95% CI 1.01–2.89; <i>P</i> = 0.045) and CVD mortality (HR 2.44, 95% CI 1.17–5.06; <i>P</i> = 0.018) after PTX. <h3>Conclusion</h3> In this PTX-treated cohort, SS was associated with longer dialysis vintage, high bone turnover, and vascular calcification. Although PTX may provide symptomatic benefit, SS remained associated with higher long-term mortality after PTX and may reflect irreversible systemic damage.