Development of a risk-prediction model for primary aldosteronism in veterans with hypertension.
Development of a risk-prediction model for primary aldosteronism in veterans with hypertension.
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开发患有高血压的退伍军人原发性醛固酮增多症的风险预测模型。
DOI：
10.1016/j.surg.2023.04.063
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发表时间：
2024
期刊：
影响因子：
3.8
通讯作者：
Wachtel,Heather
中科院分区：
文献类型：
--
作者：
Ginzberg,SaraP;Kalva,Saiesh;Wirtalla,ChristopherJ;Passman,JesseE;Cohen,DebbieL;Cohen,JordanaB;Wachtel,Heather
背景符合标准的原发性醛固酮增多症患者的筛查率极低（1%-3%）。为了帮助临床医生优先筛选患者最有可能受益，我们开发了一个风险预测model.MethodsUsing国家退伍军人健康管理局的数据，我们确定了谁符合2000年至2019年之间的原发性醛固酮增多症筛查标准的患者。我们进行了多变量逻辑回归，以确定与原发性醛固酮增多症阳性检测相关的特征，然后根据系数生成风险评分系统（0< β < 0.5 = 1点，0.5 ≤ β < 1 = 2点，1 ≤ β < 1.5 = 3点），然后使用内部验证队列测试系统性能。190名符合原发性醛固酮增多症筛查标准的患者，其中1.6%接受了筛查，15%检测呈阳性。基于回归模型，我们生成了一个风险评分系统，该系统基于总共9个可能的点，其中年龄在50岁以下、无吸烟史和顽固性高血压各得1分;血清钠升高2分;低钾血症3分。筛查阳性率随着风险评分的增加而增加，0分者中有5.6%至6.7%检测为阳性; 1分者中有7.9%至9.0%检测为阳性; 2分者中有8.6%至10%检测为阳性; 3分者中有13%至14%检测为阳性; 4分者中有21%检测为阳性; 5分者中有22%至38%检测为阳性; 6分者中有27%至38%检测为阳性; 7分者中有42%至49%检测为阳性;结论在符合原发性醛固酮增多症筛查标准的高血压患者中，筛查阳性率为5.6%~ 51%。使用我们的风险预测模型结合这些因素可以确定患者最有可能从测试中受益。
BackgroundRates of screening for primary aldosteronism in patients who meet the criteria are exceedingly low (1%–3%). To help clinicians prioritize screening in patients most likely to benefit, we developed a risk-prediction model.MethodsUsing national Veterans Health Administration data, we identified patients who met the criteria for primary aldosteronism screening between 2000 and 2019. We performed multivariable logistic regression to identify characteristics associated with positive primary aldosteronism testing before generating a risk-scoring system based on the coefficients (0< β < 0.5 = 1 pt, 0.5 ≤ β < 1 = 2 pts, 1 ≤ β < 1.5 = 3 pts) and then tested the system performance using an internal validation cohort.ResultsWe identified 502,190 patients who met primary aldosteronism screening criteria, of whom 1.6% were screened and 15% tested positive. Based on the regression model, we generated a risk-scoring system based on a total of 9 possible points in which age under 50, absence of smoking history, and resistant hypertension each scored 1 point; elevated serum sodium 2 points; and hypokalemia 3 points. Rates of positive screening increased with risk score, with 5.6% to 6.7% of those scoring 0 points testing positive; 7.9% to 9.0% 1 point; 8.6% to 10% 2 points; 13% to 14% 3 points; 21% 4 points; 22% to 38% 5 points; 27% to 38% 6 points; 42% to 49% 7 points; and 50% to 51% ≥8 points.ConclusionIn hypertensive patients who meet the criteria for primary aldosteronism screening, rates of positive screening range from 5.6% to 51%. Use of our risk-predication model incorporating these factors can identify patients most likely to benefit from testing.