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Nomogram-Based Preoperative Score for Predicting Clinical Outcome in Unilateral Primary Aldosteronism.

Yi Yang1, Tracy Ann Williams2,3, Ying Song1

  • 1Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

The Journal of Clinical Endocrinology and Metabolism
|September 8, 2020
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Summary

A new nomogram-based preoperative score (NBPS) effectively predicts hypertension remission after surgery for unilateral primary aldosteronism (UPA). This tool aids in assessing patient outcomes following adrenalectomy.

Keywords:
ARSPASO scoreclinical outcomenomogramunilateral PA

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Hypertension Management

Background:

  • Over half of patients with unilateral primary aldosteronism (UPA) experience persistent hypertension post-unilateral adrenalectomy.
  • Predicting surgical outcomes is crucial for managing UPA patients.

Purpose of the Study:

  • To develop and validate a nomogram-based preoperative score (NBPS) for predicting clinical outcomes after unilateral adrenalectomy in UPA patients.
  • To compare the predictive performance of the NBPS against existing scores like ARS and PASO.

Main Methods:

  • Developed the NBPS in an Asian cohort, incorporating predictors like sex, hypertension duration, aldosterone-to-renin ratio, and target organ damage.
  • Validated the NBPS in a Caucasian cohort, assessing its predictive performance using C indices and calibration curves.
  • Compared the NBPS's predictive accuracy (AUC) with the aldosteronoma resolution score (ARS) and primary aldosteronism surgical outcome (PASO) score.

Main Results:

  • The NBPS demonstrated superior predictive performance for hypertension remission compared to ARS and PASO in the training cohort (AUC 0.853).
  • In the validation cohort, the NBPS also showed high predictive accuracy (AUC 0.830), outperforming ARS.
  • The nomogram showed good C indices and calibration in both Asian and Caucasian cohorts.

Conclusions:

  • The nomogram-based preoperative score (NBPS) is a valuable tool for predicting clinical outcomes in UPA patients undergoing unilateral adrenalectomy.
  • The NBPS shows particular utility in predicting outcomes for Asian populations with UPA.