Does a clinical predictive scoring system accurately identify patients requiring screening and confirmation for primary aldosteronism?
A novel clinical predictive scoring system can accurately rule out primary aldosteronism or confirm it in high-risk patients, potentially reducing the need for specialized biochemical testing by approximately 40%.
BACKGROUND: Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. In Southern Thailand, the aldosterone-renin ratio (ARR) is only available within a small number of tertiary centres, necessitating need for a simple clinical assessment to determine the requirement for ARR. OBJECTIVE: This study aimed to identify predictive factors for the diagnosis of PA and generate a predictive scoring system (PSS) for use in screening and diagnosis of PA. PATIENTS AND METHODS: A total of 420 patients aged >15 years with paired plasma aldosterone concentration and plasma renin activity values allowing calculation of ARR were identified from the electronic hospital database between 2011 and 2016. RESULTS: , presence of diabetes, ≥3 antihypertensive agents, serum sodium ≥ 141 mmol/L and serum potassium 15 ng/dL and PRA 9 had specificity and PPV of 100%, essentially confirming PA in these individuals. CONCLUSION: The proposed PSS for PA will enable more focused and cost-effective use of ARR screening and confirmatory testing. In our cohort, 40% and 42% of patients would not require ARR screening or confirmatory tests, respectively.
Kietsiriroje et al. (Mon,) studied this question.