Wang Pin, Liu Limei, Lu Sen, Zhu Xianjun, Zhu Rui, Yang Yan, Zhou Guangpeng, Cao Xu
Department of Endocrinology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Intensive Care Unit, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Front Endocrinol (Lausanne). 2025 Jul 24;16:1628564. doi: 10.3389/fendo.2025.1628564. eCollection 2025.
Incomplete clinical success after unilateral adrenalectomy for primary aldosteronism (PA) remains a significant challenge, often characterized by persistent hypertension despite biochemical remission.
This study aimed to develop and validate a preoperative predictive nomogram to estimate the probability of incomplete clinical success in PA patients undergoing unilateral adrenalectomy.
A retrospective analysis was conducted on 58 PA patients who underwent adrenalectomy. Independent predictors of non-complete clinical success were identified using multivariate logistic regression. A nomogram was developed based on age, highest systolic blood pressure (SBP), and lateralization index (LI). Model performance was evaluated through the concordance index (C-index), calibration plots, and decision curve analysis, with internal validation performed via bootstrapping (1,000 resamples).
Age (OR 1.117), highest SBP (OR 1.241), and LI (OR 1.044) were independently associated with incomplete clinical success. The nomogram showed strong discriminative ability (C-index: 0.829) and good calibration. Internal validation confirmed its reliability (AUC: 0.844, sensitivity 84.2%, specificity 75.0%).
This nomogram offers a reliable, easy-to-use tool for preoperative risk stratification of PA patients, facilitating personalized postoperative management. External validation in multicenter cohorts is warranted.
原发性醛固酮增多症（PA）患者单侧肾上腺切除术后临床疗效不完全仍然是一项重大挑战，其特征通常是尽管生化指标缓解但仍存在持续性高血压。
本研究旨在开发并验证一种术前预测列线图，以估计接受单侧肾上腺切除术的PA患者临床疗效不完全的概率。
对58例行肾上腺切除术的PA患者进行回顾性分析。采用多因素逻辑回归确定临床疗效不完全的独立预测因素。基于年龄、最高收缩压（SBP）和侧别指数（LI）制定列线图。通过一致性指数（C指数）、校准图和决策曲线分析评估模型性能，并通过自抽样法（1000次重复抽样）进行内部验证。
年龄（比值比[OR] 1.117）、最高SBP（OR 1.241）和LI（OR 1.044）与临床疗效不完全独立相关。列线图显示出较强的判别能力（C指数：0.829）和良好的校准。内部验证证实了其可靠性（曲线下面积[AUC]：0.844，灵敏度84.2%，特异度75.0%）。
该列线图为PA患者术前风险分层提供了一种可靠且易于使用的工具，有助于个性化的术后管理。有必要在多中心队列中进行外部验证。
