The Primary Aldosteronism Surgical Outcome Score for the Prediction of Clinical Outcomes After Adrenalectomy for Unilateral Primary Aldosteronism.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
24
1
2019
medline:
15
12
2020
entrez:
24
1
2019
Statut:
ppublish
Résumé
To develop a prediction model for clinical outcomes after unilateral adrenalectomy for unilateral primary aldosteronism. Unilateral primary aldosteronism is the most common surgically curable form of endocrine hypertension. Surgical resection of the dominant overactive adrenal in unilateral primary aldosteronism results in complete clinical success with resolution of hypertension without antihypertensive medication in less than half of patients with a wide between-center variability. A linear discriminant analysis model was built using data of 380 patients treated by adrenalectomy for unilateral primary aldosteronism to classify postsurgical clinical outcomes. The total cohort was then randomly divided into training (280 patients) and test (100 patients) datasets to create and validate a score system to predict clinical outcomes. An online tool (Primary Aldosteronism Surgical Outcome predictor) was developed to facilitate the use of the predictive score. Six presurgical factors associated with complete clinical success (known duration of hypertension, sex, antihypertensive medication dosage, body mass index, target organ damage, and size of largest nodule at imaging) were selected based on classification performance in the linear discriminant analysis model. A 25-point predictive score was built with an optimal cut-off of greater than 16 points (accuracy of prediction = 79.2%; specificity = 84.4%; sensitivity = 71.3%) with an area under the curve of 0.839. The predictive score and the primary aldosteronism surgical outcome predictor can be used in a clinical setting to differentiate patients who are likely to be clinically cured after surgery from those who will need continuous surveillance after surgery due to persistent hypertension.
Sections du résumé
OBJECTIVE
To develop a prediction model for clinical outcomes after unilateral adrenalectomy for unilateral primary aldosteronism.
SUMMARY BACKGROUND DATA
Unilateral primary aldosteronism is the most common surgically curable form of endocrine hypertension. Surgical resection of the dominant overactive adrenal in unilateral primary aldosteronism results in complete clinical success with resolution of hypertension without antihypertensive medication in less than half of patients with a wide between-center variability.
METHODS
A linear discriminant analysis model was built using data of 380 patients treated by adrenalectomy for unilateral primary aldosteronism to classify postsurgical clinical outcomes. The total cohort was then randomly divided into training (280 patients) and test (100 patients) datasets to create and validate a score system to predict clinical outcomes. An online tool (Primary Aldosteronism Surgical Outcome predictor) was developed to facilitate the use of the predictive score.
RESULTS
Six presurgical factors associated with complete clinical success (known duration of hypertension, sex, antihypertensive medication dosage, body mass index, target organ damage, and size of largest nodule at imaging) were selected based on classification performance in the linear discriminant analysis model. A 25-point predictive score was built with an optimal cut-off of greater than 16 points (accuracy of prediction = 79.2%; specificity = 84.4%; sensitivity = 71.3%) with an area under the curve of 0.839.
CONCLUSIONS
The predictive score and the primary aldosteronism surgical outcome predictor can be used in a clinical setting to differentiate patients who are likely to be clinically cured after surgery from those who will need continuous surveillance after surgery due to persistent hypertension.
Identifiants
pubmed: 30672800
doi: 10.1097/SLA.0000000000003200
pii: 00000658-202012000-00038
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1125-1132Références
Milliez P, Girerd X, Plouin PF, et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45:1243–1248.
Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 2006; 48:2293–2300.
Monticone S, Burrello J, Tizzani D, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol 2017; 69:1811–1820.
Calhoun DA, Nishizaka MK, Zaman MA, et al. Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 2002; 40:892–896.
Stowasser M, Gordon RD. Primary aldosteronism: changing definitions and new concepts of physiology and pathophysiology both inside and outside the kidney. Physiol Rev 2016; 96:1327–1384.
Williams TA, Reincke M. Management of endocrine: diagnosis and management of primary aldosteronism: the Endocrine Society guideline 2016 revisited. Eur J Endocrinol 2018; 179:R19–R29.
Sechi LA, Novello M, Lapenna R, et al. Long-term renal outcomes in patients with primary aldosteronism. JAMA 2006; 295:2638–2645.
Sechi LA, Colussi G, Di Fabio A, et al. Cardiovascular and renal damage in primary aldosteronism: outcomes after treatment. Am J Hypertens 2010; 23:1253–1260.
Mulatero P, Monticone S, Bertello C, et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 2013; 98:4826–4833.
Monticone S, D’Ascenzo F, Moretti C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2018; 6:41–50.
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101:1889–1916.
Kempers MJ, Lenders JW, van Outheusden L, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med 2009; 151:329–337.
Williams TA, Burrello J, Sechi LA, et al. Computed tomography and adrenal venous sampling in the diagnosis of unilateral primary aldosteronism. Hypertension 2018; 72:641–649.
Williams TA, Lenders JWM, Mulatero P, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol 2017; 5:689–699.
Lumachi F, Ermani M, Basso SM, et al. Long-term results of adrenalectomy in patients with aldosterone- producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg 2005; 71:864–869.
White ML, Gauger PG, Doherty GM, et al. The role of radiologic studies in the evaluation and management of primary hyperaldosteronism. Surgery 2008; 144:926–933.
Zarnegar R, Young WF Jr, Lee J, et al. The aldosteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. Ann Surg 2008; 247:511–518.
Steichen O, Zinzindohoué F, Plouin PF, et al. Outcomes of adrenalectomy in patients with unilateral primary aldosteronism: a review. Horm Metab Res 2012; 44:221–227.
Rossi GP, Cesari M, Cuspidi C, et al. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension 2013; 62:62–69.
Letavernier E, Peyrard S, Amar L, et al. Blood pressure outcome of adrenalectomy in patients with primary hyperaldosteronism with or without unilateral adenoma. J Hypertens 2008; 26:1816–1823.
Mourad JJ, Girerd X, Milliez P, et al. Urinary aldosterone-to-active-renin ratio: a useful tool for predicting resolution of hypertension after adrenalectomy in patients with aldosterone-producing adenomas. Am J Hypertens 2008; 21:742–747.
Utsumi T, Kawamura K, Imamoto T, et al. High predictive accuracy of Aldosteronoma Resolution Score in Japanese patients with aldosterone-producing adenoma. Surgery 2012; 151:437–443.
Pasquier L, Kirouani M, Fanget F, et al. Assessment of the Aldosteronoma resolution score as a predictive resolution score of hypertension after adrenalectomy for aldosteronoma in French patients. Langenbecks Arch Surg 2017; 402:309–314.
Miller BS, Turcu AF, Nanba AT, et al. Refining the definitions of biochemical and clinical cure for primary aldosteronism using the primary aldosteronism surgical outcome (PASO) classification system. World J Surg 2018; 42:453–463.
2011; Nishikawa T, Omura M, Satoh F, et al. Task Force Committee on Primary Aldosteronism, The Japan Endocrine Society. Guidelines for the diagnosis and treatment of primary aldosteronism-the Japan Endocrine Society 2009JT Endocr J. 58:711–721.
James G, Witten D, Hastie T, et al. Chapter 4.4: Linear discriminant analysis. In: An Introduction to Statistical Learning. Springer texts in Statistics; 2014:138–149.
Hastie T, Tibshirani R, Friedman J. Chapter 4: Linear methods for classification. In: The Elements of Statistical Learning. Springer Series in Statistics; 2001:106–119.
Meyer LS, Wang X, Sušnik E, et al. Immunohistopathology and steroid profiles associated with biochemical outcomes after adrenalectomy for unilateral primary aldosteronism. Hypertension 2018; 72:650–657.
Yamamoto KN, Ishii M, Inoue Y, et al. Prediction of postoperative liver regeneration from clinical information using a data-led mathematical model. Sci Rep 2016; 6:34214.
Williams TA, Peitzsch M, Dietz AS, et al. Genotype-specific steroid profiles associated with aldosterone-producing adenomas. Hypertension 2016; 67:139–145.
Eisenhofer G, Dekkers T, Peitzsch M, et al. Mass spectrometry-based adrenal and peripheral venous steroid profiling for subtyping primary aldosteronism. Clin Chem 2016; 62:514–524.
Zhou W, Liu Y, Yuan Q, et al. Epileptic seizure detection using lacunarity and Bayesian linear discriminant analysis in intracranial EEG. IEEE Trans Biomed Eng 2013; 60:3375–3381.
Muth A, Ragnarsson O, Johannsson G, et al. Systematic review of surgery and outcomes in patients with primary aldosteronism. Br J Surg 2015; 102:307–317.
Proye CA, Mulliez EA, Carnaille BM, et al. Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism? Surgery 1998; 124:1128–1133.
Williams B, Mancia G, Spiering W, et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021–3104.
Rossi GP, Bernini G, Desideri G, et al. Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 2006; 48:232–238.
Hundemer GL, Curhan GC, Yozamp N, et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol 2018; 6:51–59.
Hundemer GL, Curhan GC, Yozamp N, et al. Renal outcomes in medically and surgically treated primary aldosteronism. Hypertension 2018; 72:768–774.