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Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism
Background: To propose a trifecta that summarizes endpoints and predicts their maintenance after adrenalectomy (n = 90) for unilateral primary aldosteronism (UPA). Methods: Trifecta was defined as coexistence of: ≥50% antihypertensive therapeutic intensity score reduction (∆TIS), no hypokalemia at 3...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836466/ https://www.ncbi.nlm.nih.gov/pubmed/35160247 http://dx.doi.org/10.3390/jcm11030794 |
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author | Anceschi, Umberto Mormando, Marilda Fiori, Cristian Zappalà, Orazio De Concilio, Bernardino Brassetti, Aldo Carrara, Alessandro Ferriero, Maria Consiglia Tuderti, Gabriele Misuraca, Leonardo Bove, Alfredo Maria Mastroianni, Riccardo Chiefari, Alfonsina Appetecchia, Marialuisa Tirone, Giuseppe Porpiglia, Francesco Celia, Antonio Gallucci, Michele Simone, Giuseppe |
author_facet | Anceschi, Umberto Mormando, Marilda Fiori, Cristian Zappalà, Orazio De Concilio, Bernardino Brassetti, Aldo Carrara, Alessandro Ferriero, Maria Consiglia Tuderti, Gabriele Misuraca, Leonardo Bove, Alfredo Maria Mastroianni, Riccardo Chiefari, Alfonsina Appetecchia, Marialuisa Tirone, Giuseppe Porpiglia, Francesco Celia, Antonio Gallucci, Michele Simone, Giuseppe |
author_sort | Anceschi, Umberto |
collection | PubMed |
description | Background: To propose a trifecta that summarizes endpoints and predicts their maintenance after adrenalectomy (n = 90) for unilateral primary aldosteronism (UPA). Methods: Trifecta was defined as coexistence of: ≥50% antihypertensive therapeutic intensity score reduction (∆TIS), no hypokalemia at 3 months, and no Clavien grade 2–5. Logistic regression was used to identify predictors of trifecta. Probability of clinical, biochemical, and simultaneous success according to trifecta were assessed by Kaplan–Meier. Cox regression was used to identify predictors of long-term clinical, biochemical, and simultaneous success. For all analyses, a two-sided p < 0.05 was considered significant. Results: Simultaneous success rate was 50%. On multivariable analysis, TIS was an independent predictor of trifecta achievement (HR 3.28; 95% CI 1.07–10.9; p = 0.03). At Kaplan–Meier, trifecta predicted higher success for all endpoints (each p < 0.03). On multivariable Cox analysis, adenoma size (AS) ≥6 cm and trifecta were independent predictors of biochemical (AS: HR 2.87; 95% CI 1.53–5.36; trifecta: HR 2.1; 95% CI 1.13–3.90; each p < 0.02) and simultaneous success (AS: HR 3.81; 95% CI 1.68–8.65; trifecta: HR 4.29; 95% CI 2.08–8.86; each p < 0.01), while trifecta was an independent predictor of complete clinical success (HR 2.84; 95% CI 1.45–5.58; p < 0.01). Conclusions: Trifecta and AS are independent predictors of either long-term complete clinical, biochemical, or combined success after adrenalectomy for UPA. |
format | Online Article Text |
id | pubmed-8836466 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-88364662022-02-12 Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism Anceschi, Umberto Mormando, Marilda Fiori, Cristian Zappalà, Orazio De Concilio, Bernardino Brassetti, Aldo Carrara, Alessandro Ferriero, Maria Consiglia Tuderti, Gabriele Misuraca, Leonardo Bove, Alfredo Maria Mastroianni, Riccardo Chiefari, Alfonsina Appetecchia, Marialuisa Tirone, Giuseppe Porpiglia, Francesco Celia, Antonio Gallucci, Michele Simone, Giuseppe J Clin Med Article Background: To propose a trifecta that summarizes endpoints and predicts their maintenance after adrenalectomy (n = 90) for unilateral primary aldosteronism (UPA). Methods: Trifecta was defined as coexistence of: ≥50% antihypertensive therapeutic intensity score reduction (∆TIS), no hypokalemia at 3 months, and no Clavien grade 2–5. Logistic regression was used to identify predictors of trifecta. Probability of clinical, biochemical, and simultaneous success according to trifecta were assessed by Kaplan–Meier. Cox regression was used to identify predictors of long-term clinical, biochemical, and simultaneous success. For all analyses, a two-sided p < 0.05 was considered significant. Results: Simultaneous success rate was 50%. On multivariable analysis, TIS was an independent predictor of trifecta achievement (HR 3.28; 95% CI 1.07–10.9; p = 0.03). At Kaplan–Meier, trifecta predicted higher success for all endpoints (each p < 0.03). On multivariable Cox analysis, adenoma size (AS) ≥6 cm and trifecta were independent predictors of biochemical (AS: HR 2.87; 95% CI 1.53–5.36; trifecta: HR 2.1; 95% CI 1.13–3.90; each p < 0.02) and simultaneous success (AS: HR 3.81; 95% CI 1.68–8.65; trifecta: HR 4.29; 95% CI 2.08–8.86; each p < 0.01), while trifecta was an independent predictor of complete clinical success (HR 2.84; 95% CI 1.45–5.58; p < 0.01). Conclusions: Trifecta and AS are independent predictors of either long-term complete clinical, biochemical, or combined success after adrenalectomy for UPA. MDPI 2022-02-01 /pmc/articles/PMC8836466/ /pubmed/35160247 http://dx.doi.org/10.3390/jcm11030794 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Anceschi, Umberto Mormando, Marilda Fiori, Cristian Zappalà, Orazio De Concilio, Bernardino Brassetti, Aldo Carrara, Alessandro Ferriero, Maria Consiglia Tuderti, Gabriele Misuraca, Leonardo Bove, Alfredo Maria Mastroianni, Riccardo Chiefari, Alfonsina Appetecchia, Marialuisa Tirone, Giuseppe Porpiglia, Francesco Celia, Antonio Gallucci, Michele Simone, Giuseppe Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism |
title | Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism |
title_full | Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism |
title_fullStr | Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism |
title_full_unstemmed | Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism |
title_short | Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism |
title_sort | surgical quality, antihypertensive therapy, and electrolyte balance: a novel trifecta to assess long-term outcomes of adrenal surgery for unilateral primary aldosteronism |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836466/ https://www.ncbi.nlm.nih.gov/pubmed/35160247 http://dx.doi.org/10.3390/jcm11030794 |
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