Do multiple types of confirmatory tests improve performance in predicting subtypes of primary aldosteronism?
Authors' conclusion
Our data suggest that patients with positive case detection undergo one confirmatory test to determine the indication for AVS.
Study context
- Population
- Patients with primary aldosteronism (PA) who underwent saline infusion test (SIT) and captopril challenge test (CCT) and were subtyped by adrenal venous sampling (AVS) (unilateral, n = 99; bilateral, n = 516), referral centrestraining and test data sets
- Participants
- 615 patients
- Exposure
- SIT + CCT combination vs SIT alone vs CCT alone for predicting PA subtype
- Outcome
- AUC and clinical usefulness (decision curve analysis) for subtype prediction in the test data set
Methodological detailsretrospective, referral centres, machine learning, training and test data sets
- Retrospective
- Referral centres
- Machine learning
- Training and test data sets
Main finding
As reported in the abstract
AUC for PA subtype prediction (test data set)
| Group | AUC |
|---|---|
| SIT + CCT | 0.850 |
| SIT | 0.813 |
| CCT | 0.786 |
AUC
SIT + CCT0.850
SIT0.813
CCT0.786
Observational data: associations, not effects.
Further findings
AUC of baseline clinical characteristics alone and combined with confirmatory tests
- Baseline clinical characteristics alone, AUC
- 0.872
- Clinical characteristics + SIT, AUC
- 0.868
- Clinical characteristics + CCT, AUC
- 0.854
- Clinical characteristics + SIT + CCT, AUC
- 0.855
- No significant improvement in AUC
Decision curve analysis
- Additional clinical usefulness of the second confirmatory test was unremarkable
Original publication
Do multiple types of confirmatory tests improve performance in predicting subtypes of primary aldosteronism? Clin Endocrinol (Oxf). Published 1 December 2022. doi:10.
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