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.

Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long‐Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism / Anceschi, U.; Mormando, M.; Fiori, C.; Zappala, O.; De Concilio, B.; Brassetti, A.; Carrara, A.; Ferriero, M. C.; Tuderti, G.; Misuraca, L.; Bove, A. M.; Mastroianni, R.; Chiefari, A.; Appetecchia, M.; Tirone, G.; Porpiglia, F.; Celia, A.; Gallucci, M.; Simone, G.. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 11:3(2022). [10.3390/jcm11030794]

Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long‐Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism

Anceschi U.;Brassetti A.;Ferriero M. C.;Tuderti G.;Misuraca L.;Bove A. M.;Mastroianni R.;Chiefari A.;Appetecchia M.;Gallucci M.;
2022

Abstract

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.
2022
Adrenalectomy; Conn’s syndrome; PASO; Primary aldosteronism; Trifecta
01 Pubblicazione su rivista::01a Articolo in rivista
Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long‐Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism / Anceschi, U.; Mormando, M.; Fiori, C.; Zappala, O.; De Concilio, B.; Brassetti, A.; Carrara, A.; Ferriero, M. C.; Tuderti, G.; Misuraca, L.; Bove, A. M.; Mastroianni, R.; Chiefari, A.; Appetecchia, M.; Tirone, G.; Porpiglia, F.; Celia, A.; Gallucci, M.; Simone, G.. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 11:3(2022). [10.3390/jcm11030794]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1616788
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