The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series
Abstract
:1. Introduction
2. Material and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Overall Cohort | Total Adrenalectomy | Partial Adrenalectomy | p |
---|---|---|---|---|
Age at surgery (median, IQR) | 54 (44–65) | 54 (44.5–63) | 57 (43.5–67.5) | 0.408 |
Follow-up (months, median, range) | 42 (27–54) | 41 (24–50) | 46 (32.7–57.5) | 0.223 |
Gender (n, %) | 0.519 | |||
Male | 36 (40%) | 23 (37.7%) | 13 (44.8%) | |
Female | 54 (60%) | 38 (62.3%) | 16 (55.2%) | |
ASA score (n, %) | 0.763 | |||
1–2 | 73 (81.1%) | 50 (82%) | 23 (79.3%) | |
3–4 | 17 18.9% | 11 (18%) | 6 (20.7%) | |
Adrenal mass size (cm, n, IQR) | 3 (2–5) | 4.2 (2.35–6) | 2.7 (1.8–2.85) | 0.001 |
Side (n, %) | 0.001 | |||
Left | 45 (50%) | 23 (37.7%) | 22 (75.9%) | |
Rigth | 45 (50%) | 38 (62.3%) | 7 (24.1%) | |
Preoperative Hypertension (n, %) | 0.456 | |||
Yes | 80 (88,8%) | 3 (86.8%) | 27 (93,1%) | |
No | 10 (11,2%) | 8 (13.2%) | 2 (6,9 %) | |
Preoperative Hypokalemia (n, %) | 0.184 | |||
Yes | 63 (70%) | 21 (65.6%) | 6 (20.7%) | |
No | 27 (30%) | 40 (34.4%) | 23 (79.3%) | |
Number of drugs (n, %) | 0.676 | |||
One class medication | 9 (10%) | 7 (11.4%) | 2 (6.8%) | |
No drugs | 50 (55.5%) | 32 (52.4%) | 18 (62%) | |
Combined class medication (≥2) | 31 (34.5%) | 22 (36%) | 9 (31.2%) | |
Preoperative TIS score (median, IQR) | 0.5 (0.25–1) | 0.5 (0.25–1.09) | 0.5 (0.25–1) | 0.989 |
Variable | Overall Cohort | Total Adrenalectomy | Partial Adrenalectomy | p |
---|---|---|---|---|
Preoperative Hb (g/dL, median, IQR) | 13.8 (12.8–14.6) | 13.4 (12.5–14.3) | 14.3 (13.4–14.9) | 0.058 |
Postoperative Hb (g/dL, median, IQR) | 12.6 (11.7–13.5) | 12.3 (11.6–13.4) | 13.3 (11.7–13.5) | 0.271 |
ΔHb (g/dL, median, IQR) | 1.1 (0.3–2.1) | 1.1 (0.1–1.8) | 1.1 (0.4–2.35) | 0.337 |
LOS (days, median, IQR) | 4 (3–5) | 4 (3–5) | 3 (2.5–4) | 0.038 |
Overall complications (n, %) | 10 (11.1%) | 7 (11.5%) | 3 (10.3%) | 0.873 |
Perioperative transfusions rate (n, %) | 3 (3.4%) | 2 (3.2%) | 1 (3.4%) | 0.967 |
Clavien Grade (n, %) | ||||
I | n = 6 | n = 4 | n = 2 | |
II | n = 3 | n = 2 | n = 1 | 0.940 |
III | - | - | - | |
IV | n = 1 | n = 1 | - | 0.488 |
V | - | - | - | |
Follow-up (months, median range) | 42 (27–54) | 41 (24–50) | 46 (32.7–57.5) | 0.223 |
Histology (n, %) | 0.209 | |||
Adenoma | 70 (77.8%) | 48 (78.7%) | 22 (75.8%) | |
Hyperplasia | 20 (22.2%) | 13 (21.3%) | 7 (24.1%) |
Variable | Overall Cohort | Total Adrenalectomy | Partial Adrenalectomy | p |
---|---|---|---|---|
Complete clinical success | ||||
- No medication/Controlled BP | 54 (60%) | 33 (54%) | 21 (72.4%) | 0.097 |
Partial clinical success | 16 (17.7%) | 14 (23%) | 2 (6.8%) | 0.136 |
- Drug Escalation (Controlled BP) | 8 (8.9%) | 7 (11.5%) | 1 (3.4%) | |
- Switch to a lower class of medication (Controlled BP) | 2 (2.2%) | 2 (3.3%) | - | |
- No drugs (Moderate BP Reduction) | 4 (4.4%) | 4 (6.6%) | - | |
- Switch to comparable medication (Moderate BP Reduction) | 2 (2.2%) | 1 (1.6%) | 1 (3.4%) | |
Absent clinical success | 20 (22.3%) | 14 (23%) | 6 (20.7%) | 0.136 |
- Unchanged dosage medication | 14 (15.6%) | 9 (14.8%) | 5 (17.2%) | |
- Increased dosage | 3 (3.3%) | 3 (4.9%) | - | |
- Switch to a stronger class of medication | 3 (3.3%) | 2 (3.3%) | 1 (3.4%) | |
Hypokalemia (n, %) | 12 (13.3%) | 9 (14.8%) | 3 (10.3%) | 0.565 |
Variable | Univariable Analysis | Multivariable Analysis | ||||||
---|---|---|---|---|---|---|---|---|
HR | 95.0% CI | HR | 95.0% CI | |||||
Lower | Higher | p Value | Lower | Higher | p Value | |||
Age | 0.98 | 0.95 | 1.01 | 0.17 | - | - | - | - |
Gender | 1.18 | 0.62 | 2.26 | 0.59 | - | - | - | - |
ASA score (1–2 vs. 3–4) | 0.65 | 0.30 | 1.38 | 0.26 | - | - | - | - |
Adenoma size | 1.12 | 1.01 | 1.24 | 0.035 | 1.11 | 1 | 1.23 | 0.049 |
Partial vs. Total Adrenalectomy | 1.21 | 0.65 | 2.25 | 0.55 | - | - | - | - |
TIS score <1 | 0.25 | 0.11 | 0.56 | 0.001 | 0.25 | 0.11 | 0.57 | 0.001 |
Surgical complications (Clavien 2–5) | 2.76 | 0.05 | 7.23 | 0.77 | - | - | - | - |
Variable | Univariable Analysis | Multivariable Analysis | ||||||
---|---|---|---|---|---|---|---|---|
HR | 95.0% CI | HR | 95.0% CI | |||||
Lower | Higher | p Value | Lower | Higher | p Value | |||
Age | 1.01 | 0.97 | 1.04 | 0.62 | - | - | - | - |
Gender | 1.15 | 0.54 | 2.47 | 0.70 | - | - | - | - |
ASA score (1–2 vs. 3–4) | 0.85 | 0.36 | 1.96 | 0.70 | - | - | - | - |
Adenoma size | 1.13 | 0.99 | 1.28 | 0.06 | - | - | - | - |
Partial vs. Total Adrenalectomy | 1.66 | 0.75 | 3.66 | 0.21 | - | - | - | - |
TIS score ≥1 | 2.97 | 1.39 | 6.33 | 0.005 | 2.84 | 1.32 | 6.1 | 0.007 |
Surgical complications (Clavien 2–5) | 10.75 | 1.29 | 89.4 | 0.028 | 6.46 | 0.76 | 54.6 | 0.08 |
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Anceschi, U.; Mormando, M.; Flammia, R.S.; Fiori, C.; Zappalà, O.; De Concilio, B.; Brassetti, A.; Carrara, A.; Ferriero, M.C.; Tuderti, G.; et al. The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series. J. Clin. Med. 2023, 12, 997. https://doi.org/10.3390/jcm12030997
Anceschi U, Mormando M, Flammia RS, Fiori C, Zappalà O, De Concilio B, Brassetti A, Carrara A, Ferriero MC, Tuderti G, et al. The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series. Journal of Clinical Medicine. 2023; 12(3):997. https://doi.org/10.3390/jcm12030997
Chicago/Turabian StyleAnceschi, Umberto, Marilda Mormando, Rocco Simone Flammia, Cristian Fiori, Orazio Zappalà, Bernardino De Concilio, Aldo Brassetti, Alessandro Carrara, Maria Consiglia Ferriero, Gabriele Tuderti, and et al. 2023. "The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series" Journal of Clinical Medicine 12, no. 3: 997. https://doi.org/10.3390/jcm12030997