What question did this study set out to answer?

This study aims to develop and validate a new subtype prediction score for primary aldosteronism using a large multicenter dataset.

July 19, 2018Journal of Hypertension

Development and validation of subtype prediction scores for the workup of primary aldosteronism

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Primary aldosteronism (n=1936). Intervention: New subtype prediction score vs. Existing prediction scores. Primary outcome: Positive predictive value for bilateral hyperaldosteronism.

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Key result

A new subtype prediction score of at least 8 had a positive predictive value of 93.5% for bilateral hyperaldosteronism, outperforming existing prediction scores.

Why the study?

Does a new subtype prediction score improve diagnostic accuracy for bilateral hyperaldosteronism compared to existing scores in patients with primary aldosteronism?

Population

1,936 patients with primary aldosteronism (1,290 in the development dataset and 646 in the validation dataset)

Comparison

A new subtype prediction score utilizing serum… vs Existing prediction scores

Design

Cohort, Patients were randomly assigned to the development and validation…

Authors

HKHiroki KobayashiNihon University MAMasanori AbeNihon University MSMasayoshi SomaNihon University

Discussion

Member takes

Implication

May refine non-invasive selection for adrenal venous sampling; leaves open need for external validation and prospective trials.

Key Points

This study aims to develop and validate a new subtype prediction score for primary aldosteronism using a large multicenter dataset.
Random assignment of 1936 patients with primary aldosteronism to development (1290) and validation (646) datasets.
Generated three prediction scores utilizing logistic regression analysis with and without confirmatory tests.
Comparison of new and existing scores evaluated through receiver operating characteristic curve and net reclassification improvement analyses.
The new prediction score, requiring at least 8 points, offered a positive predictive value of 93.5% for bilateral hyperaldosteronism.
The new prediction score outperformed existing scores in receiver operating characteristic curve analysis.
The study demonstrated improved diagnostic accuracy and feasibility for patient selection in adrenal venous sampling.

Study Design

Type

Observational (n=1,936)

Multicenter

Yes

Structured PICO

Does a new subtype prediction score improve diagnostic accuracy for bilateral hyperaldosteronism compared to existing scores in patients with primary aldosteronism?

Population

1,936 patients with primary aldosteronism used to develop and validate a new subtype prediction score.

Exposure

A new subtype prediction score utilizing serum potassium levels, absence of adrenal nodules on CT, baseline plasma aldosterone concentration, baseline aldosterone/renin ratio, and female sex

Comparator

Existing prediction scores

Outcome

Diagnostic accuracy for bilateral hyperaldosteronism (assessed via receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement analyses)

A newly developed and validated 5-item clinical prediction score accurately identifies bilateral hyperaldosteronism, which may help clinicians better select patients requiring invasive adrenal venous sampling.

Cite This Study

Kobayashi et al. (2018) conducted an observational in Primary aldosteronism (n=1,936). New subtype prediction score vs. Existing prediction scores was evaluated on Positive predictive value for bilateral hyperaldosteronism. A new subtype prediction score of at least 8 had a positive predictive value of 93.5% for bilateral hyperaldosteronism, outperforming existing prediction scores.

synapsesocial.com/papers/6a2a6ec8d2e25e35e08fa86d https://doi.org/10.1097/hjh.0000000000001855

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Development and validation of subtype prediction scores for the workup of primary aldosteronism

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Development and validation of subtype prediction scores for the workup of primary aldosteronism

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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