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Assessment of performance of stratum-specific likelihood ratios of the aldosteronoma resolution score for predicting hypertension cure after adrenalectomy for primary aldosteronism: a systematic review and meta-analysis

Journal of Human Hypertension volume 37, pages 532–541 (2023)Cite this article

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Abstract

The Aldosteronoma Resolution Score (ARS) is the most studied scoring system for predicting the high likelihood of hypertension cure after adrenalectomy for unilateral primary aldosteronism (PA). However, the ARS’s accuracy in PA patients worldwide is uncertain. We aimed to perform a meta-analysis of the accuracy, discrimination, and calibration of the ARS using stratum-specific likelihood ratios (SSLR) by organizing available data from cohort studies. We searched PubMed, Embase (Ovid), the Cochrane CENTRAL, Web of Science to November 2021 according to PRISMA statement. The quality assessment used adapted TRIPOD and PROBAST criteria. Thirteen studies comprising 2158 PA patients from North America (43%), Europe (32%), Asia (22%), and other continents, were included. The pooled estimate of the area under the receiver operating characteristic curve for all studies was 0.77 (95% CI: 0.73–0.81), and the ratio of the observed to expected complete resolution of hypertension (CRH) for all studies was 0.9 (95% CI: 0.8–1.0). The summary estimates of the SSLR for all studies were 0.31, 0.89, and 3.1, for the low (ARS 0–1), medium (ARS 2–3), and high-likelihood group (ARS 4–5) of CRH, respectively. However, substantial heterogeneity existed among studies. Follow-up period, and adrenalectomy AVS (adrenal vein sampling)-guided served as potential sources of heterogeneity for quantitative studies, which were measurement and reference standard for qualitative studies selection. In conclusion, in patients with unilateral PA, the ARS is currently an accurate prediction tool, the easiest and cheapest, for identifying long-term high likelihood of CRH after adrenalectomy, particularly when the adrenalectomy is AVS-guided.

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Authors and Affiliations

  1. Internal Medicine Unit, San Bortolo Hospital, U.L.S.S. 8 Berica - Viale Rodolfi 37, 36100, Vicenza, Italy

    Luigi Marzano

  2. Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen, Germany

    Faeq Husain-Syed

  3. Laboratory of Molecular Pharmacology, Faculty of Health Sciences, University of Brasília, Asa Norte, 70910-900, Brasília, Brazil

    Thiago Reis

  4. Department of Nephrology and Kidney Transplantation, Clinica de Doenças Renais de Brasilia - DFSTAR Hospital, Rede D’Or São Luiz, SEP/Sul 710/910 Vital Brasília, 70390–108, Brasília, Brazil

    Thiago Reis

  5. Department of Medicine (DIMED), Università di Padova, Via Giustiniani, 2–35128, Padua, Italy

    Claudio Ronco

  6. Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza (IRRIV), Viale Rodolfi, 37–36100, Vicenza, Italy

    Claudio Ronco & Monica Zanella

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Contributions

Concept and design of the study: LM, CR. Literature research and clinical advice: LM, FHS, TR, CR, MZ. Acquisition, analyses, or interpretation of data: LM. Manuscript drafting: LM. Critical revision of the manuscript for important intellectual content: LM, FHS, TR, CR, MZ. Study supervision: TR, CR.

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Correspondence to Luigi Marzano.

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Marzano, L., Husain-Syed, F., Reis, T. et al. Assessment of performance of stratum-specific likelihood ratios of the aldosteronoma resolution score for predicting hypertension cure after adrenalectomy for primary aldosteronism: a systematic review and meta-analysis. J Hum Hypertens 37, 532–541 (2023). https://doi.org/10.1038/s41371-022-00731-8

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