Assessment of the Aldosteronona resolution score as a predictive resolution score of hypertension after adrenalectomy for aldosteronoma in French patients

Pasquier, Ludwig; Kirouani, Medhi; Fanget, Florian; Nominé, Claire; Caillard, C.; Arnault, Vincent; Finel, Jean-Baptiste; Christou, Niki; Mathonnet, Muriel; Trésallet, Christophe; Hamy, A.; Calan, Loïc de; Brunaud, Laurent; Ménégaux, Fabrice; Lifante, Jean Christophe; Hardouin, Jean-Benoît; Drui, Delphine; Mirallié, Éric; Blanchard, Claire

doi:10.1007/s00423-017-1557-x

Cited by 20 publications

(22 citation statements)

References 16 publications

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“…Although our analysis showed a significant difference between the ARS score in groups of hypertension remission after surgery, only 2 of 4 parameters included in the ARS were independent factors of normalization of arterial blood pressure in our population. Similar findings were recently published by other authors [ 28 ].…”

Section: Discussionsupporting

confidence: 93%

Short- and long-term results of laparoscopic adrenalectomy for Conn's syndrome.

Wierdak¹,

Sokołowski²,

Natkaniec³

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionThe primary treatment of Conn’s syndrome (CS) is laparoscopic adrenalectomy and aims to normalize arterial blood pressure and biochemical parameters.AimTo analyse short- and long-term results of laparoscopic adrenalectomy for Conn’s syndrome (CS).Material and methodsThe analysis included 44 consecutive patients, who underwent laparoscopic adrenalectomy between 2004 and 2015 for CS. We analysed short- and long-terms results of operations. All patients were followed up 6 and 24 months after surgery to determine changes in the biochemical parameters, and clinical regression of arterial hypertension. We also evaluated the aldosteronoma resolution score (ARS) in predicting the resolution of hypertension.ResultsNo conversions were needed. Complications occurred in 5 (11.4%) patients. Preoperative hypokalaemia and hypernatraemia were present in 83.4% and 15.8% of patients, respectively. After surgery, both hypokalaemia and hypernatraemia resolved in all patients. At the follow-up 6 months after the surgery, only 11.3% of patients had complete remission (CR) of hypertension. In 43.2% of cases we observed partial remission (PR). After 24 months CR was found in 13.6% of patients, 45.5% patients fulfilled criteria for PR, and 29.5% of patients changed the group of remission comparison to the first follow-up visit. Only 50% of patients with an ARS of 4 or 5 points achieved CR 6 months after surgery.ConclusionsLaparoscopic adrenalectomy is a safe method of treatment for CS. Although it effectively eliminates electrolyte imbalance, it does not allow for the CR of hypertension in the majority of patients, especially in the elderly group. We did not find ARS to be an effective tool in predicting postoperative resolution of hypertension.

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Section: Discussionsupporting

confidence: 93%

Short- and long-term results of laparoscopic adrenalectomy for Conn's syndrome.

Wierdak¹,

Sokołowski²,

Natkaniec³

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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“…This underscores the need for the evaluation of clinical applicability and usefulness of the ARS in the current clinical APA population, especially because the performance of a prediction model may change over time [20][21][22]. In the past, validation of the prediction model by others showed contradicting results; however, these studies were single center or country and frequently had small sample size [24][25][26]. Therefore, we chose to perform validation of the ARS within our large and worldwide cohort of patients, which at this time is the best available population to truly evaluate the generalizability in current real-life clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Aldosteronoma Resolution Score Within Current Clinical Practice

et al. 2019

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Introduction Complete resolution of hypertension after adrenalectomy for primary aldosteronism is far from a certainty. This stresses the importance of adequate preoperative patient counseling. The aldosteronoma resolution score (ARS) is a simple and easy to use prediction model only including four variables: B 2 antihypertensive medications, body mass index B 25 kg/m 2 , duration of hypertension B 6 years and female sex. However, because the model was developed and validated within the USA over a decade ago, the applicability in modern practice and outside of the USA is questionable. Therefore, we aimed to validate the ARS in current clinical practice within an international cohort. Materials and method Patients who underwent unilateral adrenalectomy, between 2010 and 2016, in 16 medical centers from the USA, Europe (EU), Canada (CA) and Australia (AU) were included. Resolution of hypertension was defined as normotension without antihypertensive medications. Results In total, 514 patients underwent adrenalectomy and 435 (85%) patients were eligible. Resolution of hypertension was achieved in 27% patients within the total cohort and in 22%, 30%, 40% and 38% of patients within USA, EU, CA and AU, respectively (p = 0.015). The area under the curve (AUC) for the complete cohort was 0.751. Geographic validation displayed a AUC within the USA, EU, CA and AU of 0.782, 0.681, 0.811 and 0.667, respectively. Discussion The ARS is an easy to use prediction model with a moderate to good predictive performance within current clinical practice. The model showed the highest predictive performance within North America but potentially has less predictive performance in EU and AU.

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“…A prediction score for the resolution of hypertension after surgery has been developed 17 which also performed well in a patient cohort from Japan 22 but not in a French population 23 . The aldosteronoma resolution score is based on a points system to predict 3 levels (low, medium, high) of likelihood of clinical cure.…”

Section: Introductionmentioning

confidence: 99%

The Primary Aldosteronism Surgical Outcome Score for the Prediction of Clinical Outcomes After Adrenalectomy for Unilateral Primary Aldosteronism

Burrello

Stowasser

et al. 2019

Annals of Surgery

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Objective: To develop a prediction model for clinical outcomes after unilateral adrenalectomy for unilateral primary aldosteronism. Summary Background Data: Unilateral primary aldosteronism is the most common surgically curable form of endocrine hypertension. Surgical resection of the dominant overactive adrenal in unilateral primary aldosteronism results in complete clinical success with resolution of hypertension without antihypertensive medication in less than half of patients with a wide between-center variability. Methods: A linear discriminant analysis (LDA) model was built using data of 380 patients treated by adrenalectomy for unilateral primary aldosteronism to classify post-surgical clinical outcomes. The total cohort was then randomly divided into training (280 patients) and test (100 patients) datasets to create and validate a score system to predict clinical outcomes. An online tool (PASO [Primary Aldosteronism Surgical Outcome] predictor) was developed to facilitate the use of the predictive score. Results: Six presurgical factors associated with complete clinical success (known duration of hypertension, sex, antihypertensive medication dosage, body mass index, target organ damage and size of largest nodule at imaging) were selected based on classification performance in the LDA model. A 25-point predictive score was built with an optimal cutoff of greater than 16 points (accuracy of prediction = 79.2%; specificity = 84.4%; sensitivity = 71.3%) with an area under the curve of 0.839. Conclusions: The predictive score and the PASO predictor can be used in a clinical setting to differentiate patients who are likely to be clinically cured after surgery from those who will need continuous surveillance after surgery due to persistent hypertension.

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Assessment of the Aldosteronona resolution score as a predictive resolution score of hypertension after adrenalectomy for aldosteronoma in French patients

Abstract: ARS is not a predictive score efficient enough in a French population maybe due to different metabolic data and genetic conditions.

Cited by 20 publications

References 16 publications

Short- and long-term results of laparoscopic adrenalectomy for Conn's syndrome.

Short- and long-term results of laparoscopic adrenalectomy for Conn's syndrome.

Validation of the Aldosteronoma Resolution Score Within Current Clinical Practice

The Primary Aldosteronism Surgical Outcome Score for the Prediction of Clinical Outcomes After Adrenalectomy for Unilateral Primary Aldosteronism

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