Abstract P301: Predicting Complete Resolution Of Hypertension After Adrenalectomy In Primary Aldosteronism: A Systematic Review And Meta-analysis Of Prognostic Models. Surgical Outcome of PRimary Aldosteronism progNostic mOdels (SOPRANO) Study

Abstract

Background: Unilateral primary aldosteronism (PA) is the most common surgically curable form of hypertension, despite complete clinical success after adrenalectomy being far from certain. Several presurgical factors were associated with complete resolution of hypertension (CRH). However, it remains unclear which of the available prognostic models combining those factors can be used in clinical practice to predict blood pressure-related outcomes after surgery for PA. Objectives: To identify, describe and appraise all prognostic models developed to predict CRH, and meta-analyse their predictive performances. Methods: We searched MEDLINE, Embase, and Web of Science, for development and validation studies of prognostic models according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The quality assessment used adapted TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) and PROBAST (Prediction model Risk Of Bias ASsessment Tool) criteria. After selection, we extracted descriptive statistics and aggregated area under the receiver operator curve (AUC) using meta-analysis. Results: From 25 eligible studies, we identified 12 prognostic models used for predicting CRH after total adrenalectomy in PA. We report the results for three models that had available data from at least three external validation studies: the Primary Aldosteronism Surgical Outcome (PASO) score (AUC: 0.81; 95% confidence interval [CI]: 0.74–0.86; 95% predictive interval [PI]: 0.04–1.00), Utsumi nomogram (AUC: 0.79; 95% CI: 0.72–0.85; 95% PI: 0.03–1.00), and the Aldosteronoma Resolution Score (ARS) model (AUC: 0.77; 95% CI: 0.74–0.80; 95% PI: 0.59–0.86 for all studies and AUC: 0.80; 95% CI: 0.75–0.85; 95% PI: 0.57–0.93 for the studies with the same adrenal vein sampling-guided adrenalectomy rate compared to the models meta-analyzed). Conclusions: The PASO score, Utsumi nomogram, and ARS model showed good and comparable discrimination performance to predict CRH after unilateral adrenalectomy in PA. However, unlike the ARS model, the number of external validation studies for the PASO score and the Utsumi nomogram was relatively low to draw definite conclusions.