Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Pittrof,M.
A diagnostic accuracy study of aldosterone to active renin ratio in screening for primary aldosteronism
Humanmedizin; [Diplomarbeit] Medical University of Graz;2019. pp. 58
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Pilz Stefan
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- Abstract:
- Arterial hypertension is one of the main risk factors for cardiovascular diseases and the leading cause of death in Austria, followed by cancer and respiratory diseases.[1] Primary aldosteronsim, also known as Conn syndrome, is characterised by an autonomous over-production of aldosterone leading to arterial hypertension. This disease has a prevalence of 5-10% in patients with arterial hypertension. The aldosterone to active renin ratio (AARR) is the recommended screening test for pri-mary aldosteronism (PA), but prospective study data on its sensitivity and specificity are sparse. Therefore, we investigated the diagnostic accuracy of the AARR for detecting PA in the Graz Endocrine Causes of Hypertension (GECOH) Study, a prospective diagnostic accuracy study. This study was conducted from February 2009 to August 2015 at the outpatient clinic of the Department of Endocrinology and Diabetology of the Medical University of Graz, Austria. We enrolled 400 patients with arterial hypertension who were referred to our tertiary care center for screening for endocrine hypertension. The study participants had a determination of the AARR (index test) and a second AARR determination followed by a saline infusion test (SIT) after 2 to 6 weeks. PA was diagnosed in individuals with any AARR of ≥ 3.7 ng/dL/μU/mL (including a plasma aldosterone concentration [PAC] of ≥ 9 ng/dL) who had a PAC of ≥ 10 ng/dL after the SIT. We did not substantially alter antihy-pertensive drug intake. Primary outcome was the receiver operating characteristic (ROC) curve of the AARR in diagnosing PA. Eligible for analyses were 382 participants and PA was diagnosed in 18 patients (4.7%). The area under the ROC curve of the AARR in detecting PA was 0.973 (95% confidence interval [CI]: 0.956-0.990). Sensitivity and specificity for a positive AARR in diagnosing PA were 100% (95% CI: 81.5-100.0) and 89.6% (95% CI: 86.0-92.5), respectively. We conclude that the AARR has a good diagnostic accuracy for detecting PA.