Gupta Nidhi, Dutta Aditya, Baruah Mintu Mani, Bhansali Anil, Ahuja Chirag Kamal, Dhandapani Sivashanmugam, Bhadada Sanjay Kumar, Saikia Uma Nahar, Walia Rama
Department of Endocrinology, PGIMER, Chandigarh, India.
Department of Radiology, PGIMER, Chandigarh, India.
Indian J Endocrinol Metab. 2023 Nov-Dec;27(6):501-505. doi: 10.4103/ijem.ijem_314_23. Epub 2024 Jan 11.
To derive a clinical score from parameters that favor remission of Cushing's disease (CD) after pituitary surgery.
This is an analysis of 11 clinical, hormonal, and post-operative parameters that each favored remission in a cohort of 145 patients with CD treated by trans-sphenoidal surgery (TSS). Each parameter was designated as a categorical variable (presence/absence), and several favorable parameters present for each patient were calculated. From this, a median parameter score (clinical score) of the entire cohort was derived, which was then compared to the event of remission/persistence of CD.
The median number of favorable parameters present in the entire cohort was 3 (0-7). The significant count of patients in remission increased with the increasing number of parameters. The receiver-operator characteristic curve showed that the presence of ≥3 parameters was associated with remission in CD with a sensitivity of 84.2% and a specificity of 80%. Patients with a clinical score ≥3 had significantly higher remission rates (88.9%) than those who had persistent disease (27.3%; = 0.001).
A clinical score of ≥3 predicts remission in CD treated by TSS; however, it requires validation in other large cohorts. Rather than assessing individual parameters to predict remission in CD, an integrated clinical score is a better tool for follow-up and patient counseling.
从有利于库欣病（CD）垂体手术后缓解的参数中得出一个临床评分。
对11项临床、激素和术后参数进行分析，这些参数在145例接受经蝶窦手术（TSS）治疗的CD患者队列中均有利于缓解。每个参数被指定为一个分类变量（存在/不存在），并计算每个患者存在的几个有利参数。由此得出整个队列的中位数参数评分（临床评分），然后将其与CD缓解/持续的情况进行比较。
整个队列中存在的有利参数的中位数为3（0 - 7）。缓解的患者数量随着参数数量的增加而增加。受试者工作特征曲线显示，≥3个参数的存在与CD缓解相关，敏感性为84.2%，特异性为80%。临床评分≥3的患者缓解率（88.9%）显著高于疾病持续的患者（27.3%；P = 0.001）。
临床评分≥3可预测TSS治疗的CD缓解；然而，它需要在其他大型队列中进行验证。综合临床评分是随访和患者咨询的更好工具，而不是评估单个参数来预测CD缓解。
