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The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series

Background: To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. Methods: Between 2011 and 2022, a four-center adrenalectomy dataset was queried for “unilateral adrenal mass” and “UPA” (n = 90). Preoper...

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Autores principales: Anceschi, Umberto, Mormando, Marilda, Flammia, Rocco Simone, Fiori, Cristian, Zappalà, Orazio, De Concilio, Bernardino, Brassetti, Aldo, Carrara, Alessandro, Ferriero, Maria Consiglia, Tuderti, Gabriele, Misuraca, Leonardo, Prata, Francesco, Tufano, Antonio, Bove, Alfredo Maria, Mastroianni, Riccardo, Appetecchia, Marialuisa, Tirone, Giuseppe, Porpiglia, Francesco, Celia, Antonio, Simone, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917842/
https://www.ncbi.nlm.nih.gov/pubmed/36769646
http://dx.doi.org/10.3390/jcm12030997
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author Anceschi, Umberto
Mormando, Marilda
Flammia, Rocco Simone
Fiori, Cristian
Zappalà, Orazio
De Concilio, Bernardino
Brassetti, Aldo
Carrara, Alessandro
Ferriero, Maria Consiglia
Tuderti, Gabriele
Misuraca, Leonardo
Prata, Francesco
Tufano, Antonio
Bove, Alfredo Maria
Mastroianni, Riccardo
Appetecchia, Marialuisa
Tirone, Giuseppe
Porpiglia, Francesco
Celia, Antonio
Simone, Giuseppe
author_facet Anceschi, Umberto
Mormando, Marilda
Flammia, Rocco Simone
Fiori, Cristian
Zappalà, Orazio
De Concilio, Bernardino
Brassetti, Aldo
Carrara, Alessandro
Ferriero, Maria Consiglia
Tuderti, Gabriele
Misuraca, Leonardo
Prata, Francesco
Tufano, Antonio
Bove, Alfredo Maria
Mastroianni, Riccardo
Appetecchia, Marialuisa
Tirone, Giuseppe
Porpiglia, Francesco
Celia, Antonio
Simone, Giuseppe
author_sort Anceschi, Umberto
collection PubMed
description Background: To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. Methods: Between 2011 and 2022, a four-center adrenalectomy dataset was queried for “unilateral adrenal mass” and “UPA” (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan–Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. Results: At a median follow-up of 42 months (IQR 27–54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan–Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11–0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1–1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32–6.1; p = 0.007) was the only independent predictor of absent clinical success. Conclusions: TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery.
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spelling pubmed-99178422023-02-11 The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series Anceschi, Umberto Mormando, Marilda Flammia, Rocco Simone Fiori, Cristian Zappalà, Orazio De Concilio, Bernardino Brassetti, Aldo Carrara, Alessandro Ferriero, Maria Consiglia Tuderti, Gabriele Misuraca, Leonardo Prata, Francesco Tufano, Antonio Bove, Alfredo Maria Mastroianni, Riccardo Appetecchia, Marialuisa Tirone, Giuseppe Porpiglia, Francesco Celia, Antonio Simone, Giuseppe J Clin Med Article Background: To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. Methods: Between 2011 and 2022, a four-center adrenalectomy dataset was queried for “unilateral adrenal mass” and “UPA” (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan–Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. Results: At a median follow-up of 42 months (IQR 27–54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan–Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11–0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1–1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32–6.1; p = 0.007) was the only independent predictor of absent clinical success. Conclusions: TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery. MDPI 2023-01-28 /pmc/articles/PMC9917842/ /pubmed/36769646 http://dx.doi.org/10.3390/jcm12030997 Text en © 2023 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
Flammia, Rocco Simone
Fiori, Cristian
Zappalà, Orazio
De Concilio, Bernardino
Brassetti, Aldo
Carrara, Alessandro
Ferriero, Maria Consiglia
Tuderti, Gabriele
Misuraca, Leonardo
Prata, Francesco
Tufano, Antonio
Bove, Alfredo Maria
Mastroianni, Riccardo
Appetecchia, Marialuisa
Tirone, Giuseppe
Porpiglia, Francesco
Celia, Antonio
Simone, Giuseppe
The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series
title The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series
title_full The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series
title_fullStr The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series
title_full_unstemmed The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series
title_short The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series
title_sort therapeutic intensity score as predictor of clinical outcomes after total and partial adrenalectomy for unilateral primary aldosteronism: results of a multicentric series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917842/
https://www.ncbi.nlm.nih.gov/pubmed/36769646
http://dx.doi.org/10.3390/jcm12030997
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