Zhu, R., Shagjaa, T., Rossitto, G., Caroccia, B., Seccia, T. M., Gregori, D. and Rossi, G. P. (2023) Exclusion tests in unilateral primary aldosteronism (ExcluPA) study. Journal of Clinical Endocrinology and Metabolism, 108(2), pp. 496-506. (doi: 10.1210/clinem/dgac654) (PMID:36373399)
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Abstract
Context: Determining the diagnostic accuracy of “exclusion” tests for primary aldosteronism (PA) compared to the aldosterone to renin ratio (ARR) is fundamental to avoid invasive subtyping in false-positive patients at screening. Objective: To assess the accuracy of exclusion tests for PA using the diagnosis of unilateral PA as reference. Methods: PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies published from January 1, 1970, to December 31, 2021, meeting tight quality criteria. Data were extracted following the PRISMA methodology. We performed a two-stage meta-analysis that entailed an exploratory and a validation phase based on a “golden” or “gold” diagnostic standard, respectively. Pooled specificity, negative likelihood ratio, diagnostic odds ratio, and summary area under the ROC curve (sAUROC) were calculated to analyze the accuracy of exclusion tests. Results: A meta-analysis of 31 datasets comprising a total of 4242 patients fulfilling the predefined inclusion criteria found that pooled accuracy estimates (sAUROC) did not differ between the ARR (0.95; 95% CI, 0.92-0.98), the captopril challenge test (CCT) (0.92; 95% CI, 0.88-0.97), and the saline infusion test (SIT) (0.96; 95% CI, 0.94-0.99). Solid information could not be obtained for the fludrocortisone suppression test and the furosemide upright test, which were assessed in only 1 study each. Conclusion: The apparently high diagnostic accuracy of the CCT and the SIT was due to the selection of patients with an elevated ARR and thus a high pretest probability of unilateral PA; however, neither test furnished a diagnostic gain over the ARR. Therefore, the systematic use of these exclusion tests in clinical practice is not justified by available evidence.
| Item Type: | Articles |
|---|---|
| Additional Information: | This study supported by the following research grants: FORICA (The Foundation for advanced Research In Hypertension and CArdiovascular diseases) to G.P.R., the China Scholarship Council (CSC) for PhD to R.Z., and The International PhD Program in Arterial Hypertension and Vascular Biology University of Padua, and University of Padua DOR2045593/20 to T.M.S. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Rossitto, Dr Giacomo |
| Authors: | Zhu, R., Shagjaa, T., Rossitto, G., Caroccia, B., Seccia, T. M., Gregori, D., and Rossi, G. P. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | Journal of Clinical Endocrinology and Metabolism |
| Publisher: | Oxford University Press |
| ISSN: | 0021-972X |
| ISSN (Online): | 1945-7197 |
| Published Online: | 14 November 2022 |
| Copyright Holders: | Copyright © 2022 The Authors |
| First Published: | First published in Journal of Clinical Endocrinology and Metabolism 108(2): 496-506 |
| Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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