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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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.
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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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