Screening of primary aldosteronism by clinical features and daily laboratory tests

原发性醛固酮增多症 低钾血症 医学 醛固酮 置信区间 内科学 血浆肾素活性 泌尿科 接收机工作特性 醛固酮增多症 胃肠病学 优势比 内分泌学 原发性高血压 肾素-血管紧张素系统 血压
作者
Tomohisa Yamashita,Sayaka Shimizu,Masayuki Koyama,Kouhei Ohno,Tomohiro Mita,Toshiyuki Tobisawa,Akifumi Takada,Nobuhiko Togashi,Yoshito Ohnuma,Tohru Hasegawa,Akihito Tsuchida,Toshiaki Endo,Toshiaki Ando,Hideaki Yoshida,Shingo Fukuma,Shunichi Fukuhara,Norihito Moniwa,Tetsuji Miura
出处
期刊:Journal of Hypertension [Lippincott Williams & Wilkins]
卷期号:36 (2): 326-334 被引量:9
标识
DOI:10.1097/hjh.0000000000001511
摘要

Objective: To develop and validate a scoring system for selection of patients who should proceed to endocrinologic examinations of primary aldosteronism in newly diagnosed hypertensive patients. Methods: A multivariate logistic regression analysis for primary aldosteronism was undertaken by use of seven possible primary aldosteronism markers, age less than 40 years, female sex, moderate-to-severe hypertension, hypokalemia, serum Na+ minus Cl− at least 40 mmol/l, serum uric acid 237.92 μmol/l or less (4.0 mg/dl), and urine pH (U-pH) at least 7.0, in consecutive outpatients newly diagnosed with hypertension. The diagnostic criteria of primary aldosteronism were plasma aldosterone concentration-to-plasma renin activity ratio [ARR, (ng/dl)/(ng/ml per h)] at least 20 and at least one positive result in four types of challenge tests. Results: Of 130 patients, 24 were diagnosed with primary aldosteronism. The area under the receiver operating characteristic curve (AUC) for a logistic model incorporating all possible primary aldosteronism markers was 0.73 [95% confidence interval (CI): 0.61–0.85]. Removing high U-pH, female sex, and hypokalemia from the full model decreased the AUC by 0.059, 0.035, and 0.011, respectively. We devised pH of urine, female sex, low serum K+ (PFK) score, in which one point each was assigned to high U-pH, female sex, and hypokalemia. The prevalences of primary aldosteronism in patients with 0, 1, 2, and 3 points were 11, 14, 42, and 60%, respectively. In external validation datasets (n = 106), AUC of PFK score was significantly higher than that of hypokalemia alone (0.73, 95% CI: 0.63–0.83 vs. 0.53, 95% CI: 0.44–0.63, P < 0.01). Conclusion: PFK score may be a better parameter than hypokalemia alone for identifying patients with a high probability of having primary aldosteronism.

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