Context: Determining the diagnostic accuracy of "exclusion" tests for primary aldosteronism (PA) compared to the aldosterone to renin ratio (ARR) is fundamental to avoid invasive subtyping in false-positive patients at screening.
Objective: To assess the accuracy of exclusion tests for PA using the diagnosis of unilateral PA as reference.
Methods: PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies published from January 1, 1970, to December 31, 2021, meeting tight quality criteria. Data were extracted following the PRISMA methodology. We performed a two-stage meta-analysis that entailed an exploratory and a validation phase based on a "golden" or "gold" diagnostic standard, respectively. Pooled specificity, negative likelihood ratio, diagnostic odds ratio, and summary area under the ROC curve (sAUROC) were calculated to analyze the accuracy of exclusion tests.
Results: A meta-analysis of 31 datasets comprising a total of 4242 patients fulfilling the predefined inclusion criteria found that pooled accuracy estimates (sAUROC) did not differ between the ARR (0.95; 95% CI, 0.92-0.98), the captopril challenge test (CCT) (0.92; 95% CI, 0.88-0.97), and the saline infusion test (SIT) (0.96; 95% CI, 0.94-0.99). Solid information could not be obtained for the fludrocortisone suppression test and the furosemide upright test, which were assessed in only 1 study each.
Conclusion: The apparently high diagnostic accuracy of the CCT and the SIT was due to the selection of patients with an elevated ARR and thus a high pretest probability of unilateral PA; however, neither test furnished a diagnostic gain over the ARR. Therefore, the systematic use of these exclusion tests in clinical practice is not justified by available evidence.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1210/clinem/dgac654 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
A simplified multidimensional scale approach is effective in predicting mortality in hospitalized older adults and highlights the role of nutrition.
Clin Nutr
December 2024
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Geriatric Clinic, Maggiore University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy; School of Dietetics, University of Trieste - Pordenone branch, Pordenone, Italy.
Background & Aims: Malnutrition and cognitive impairment are among the major contributors to frailty, that significantly increases the risk of mortality of older hospitalized patients. Multidimensional frailty assessment tools, such as the multidimensional prognostic index-MPI, a tool based on a standard comprehensive geriatric assessment (CGA), have proven valuable for predicting adverse outcomes, including mortality of older adults following acute illness but its application in everyday clinical practice is limited. We hypothesized that removing parameters not closely associated with mortality and sorting the patient population according to the presence or not of cognitive impairment with possible integration of common laboratory markers, could provide a simplified approach that could improve practicability in all settings with at least comparable 1-year mortality predictive value.
View Article and Find Full Text PDFOsteoporotic fracture risks of thiazides and dihydropyridines in angiotensin modulator users.
Osteoporos Int
December 2024
Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan.
Unlabelled: This study examined the impact of thiazide and RAAS antihypertensive medications vs DHP-RAAS medications on fracture risk. The close alignment of such settings with clinical use, combined with the potential bone benefits of ACEis and ARBs, provides enhanced accuracy in bone health evidence.
Purpose: To determine whether thiazides, combined with either angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), offer bone-protective benefits compared with dihydropyridine (DHP) drugs combined with ACEi or ARB.
Physical function measures in ICU survivors, where to now? A scoping review.
South Afr J Crit Care
July 2024
Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Background: Growing evidence is describing the long-term morbidity experienced by critical illness survivors, a major contributing factor being impaired physical function. Consensus is yet to be reached on which physical function measures should be included in this population. This review aimed to describe physical functioning measurement instruments used in longitudinal studies of critical illness survivors, based on the International Classification of Function (ICF).
View Article and Find Full Text PDFA Comparative Meta-Analysis on the Association of lncRNAs MALAT1, HOTAIR, and AFAP1-AS1 With the Risk of Developing Lymph Node Metastasis in Lung Cancer.
Cancer Rep (Hoboken)
December 2024
Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh.
Background: Numerous studies have demonstrated the significance of long noncoding RNA (lncRNA) in the development of cancer metastasis. The expression levels of many lncRNAs are elevated in metastatic lung cancer patients compared to non-metastatic lung cancer patients.
Objectives: The primary objective of the study was to investigate the association between the expression levels of three lncRNAs (MALAT1, HOTAIR, and AFAP1-AS1) and lymph node metastasis (LNM) of lung cancer.
Risk Score for Two Year Mortality Following Carotid Endarterectomy Performed for Symptomatic Stenosis.
J Vasc Surg
December 2024
Department of Vascular Surgery, Red Cross Hospital, Athens, Greece.
Objective: The purpose of this study is to identify variables at the time of clinical presentation which place patients at higher risk for mortality following carotid endarterectomy (CEA) for symptomatic lesions. Further, this study will create a risk score for mortality within two years following CEA for symptomatic stenosis to help tailor future postoperative and long-term management by identifying patients who require heightened vigilance in postoperative care to facilitate survival.
Methods: The Vascular Quality Initiative (VQI) CEA module was queried for procedures performed for symptomatic (within 180 days) carotid bifurcation stenosis.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!