Suurd Diederik P D, Visscher Wouter P, Vorselaars Wessel M C M, van Beek Dirk-Jan, Spiering Wilko, Borel Rinkes Inne H M, Valk Gerlof D, Vriens Menno R
Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
Ann Med Surg (Lond). 2021 Apr 20;65:102333. doi: 10.1016/j.amsu.2021.102333. eCollection 2021 May.
Cure of hypertension after adrenalectomy for primary aldosteronism is no certainty and therefore preoperative patient counseling is essential. The Primary Aldosteronism Surgical Outcome (PASO) Score is a useful prediction model with an area under the curve (AUC) of 0.839. The PASO Score includes 'Target Organ Damage' (TOD) (i.e., left ventricular hypertrophy and/or microalbuminuria), which is often unavailable during preoperative counseling and might therefore limit its use in clinical practice. We hypothesized that the PASO score would still be useful if TOD is unknown at time of counseling. Therefore, we aimed to examine the predictive performance of the simplified PASO Score, without taking TOD into account.
In this retrospective cohort study, patients who underwent unilateral adrenalectomy between 2010 and 2016 in 16 medical centers from North America, Europe and Australia were included. TOD was unknown in our database and therefore assigned as absent. Patients were classified as complete, partial or absent clinical success using the PASO consensus criteria.
A total of 380 (73.9%) patients were eligible for analysis. Complete, partial and absent clinical success were observed in 29.5%, 55.8% and 14.7% of patients, respectively. The simplified PASO Score had an AUC of 0.730 (95% confidence interval 0.674-0.785) in our total cohort.
Without taking TOD into account, the simplified PASO Score had a lower predictive value as compared to the original derivation cohort. Ideally, the complete PASO Score should be used, but when data on TOD are not readily available, the simplified PASO Score is a useful and reasonable alternative.
原发性醛固酮增多症患者肾上腺切除术后高血压能否治愈尚无定论，因此术前对患者进行咨询至关重要。原发性醛固酮增多症手术结果（PASO）评分是一种有用的预测模型，曲线下面积（AUC）为0.839。PASO评分包括“靶器官损害”（TOD）（即左心室肥厚和/或微量白蛋白尿），而这在术前咨询时往往无法获得，因此可能会限制其在临床实践中的应用。我们假设，在咨询时若TOD未知，PASO评分仍将有用。因此，我们旨在研究不考虑TOD的简化PASO评分的预测性能。
在这项回顾性队列研究中，纳入了2010年至2016年间在北美、欧洲和澳大利亚16个医疗中心接受单侧肾上腺切除术的患者。我们的数据库中未记录TOD，因此将其认定为不存在。根据PASO共识标准，将患者分为临床完全成功、部分成功或未成功。
共有380例（73.9%）患者符合分析条件。临床完全成功、部分成功和未成功的患者分别占29.5%、55.8%和14.7%。在我们的整个队列中，简化PASO评分的AUC为0.730（95%置信区间0.674 - 0.785）。
不考虑TOD时，简化PASO评分的预测价值低于原始推导队列。理想情况下，应使用完整的PASO评分，但当TOD数据难以获取时，简化PASO评分是一种有用且合理的替代方法。
