12470 International Study Evaluating Time To Adrenalectomy For Primary Aldosteronism
Notice bibliographique
Résumé
Abstract Disclosure: C. Ter Li Min: None. K. Xuan Han: None. M. Araujo-Castro: None. E. Gkaniatsa: None. M. Reincke: None. T. Viet Tran: None. H. Tran: None. M. Stowasser: None. M.A. Grytaas: None. A. Turcu: None. J. Matrozova: None. N. Sukor: None. T. Kocjan: None. R. Baudrand: None. M. Tsuiki: None. M. Murakami: None. J. Yang: None. T. Katabami: None. M. Naruse: None. M. St-Jean: None. F. Ceccato: None. T. Puar Hai Kiat: None. Background: Primary aldosteronism (PA) is a common cause of hypertension. Patients with unilateral PA can be cured by adrenalectomy. However, the time required to undergo specialised tests like adrenal vein sampling (AVS), and laparoscopic adrenalectomy may delay management. We assessed the current time-to-adrenalectomy (TTA) for patients with PA worldwide. Methods: We conducted an international, multi-center retrospective study involving 37 centers from 15 countries to determine the total time from first presentation to adrenalectomy, and each interval: screening (first presentation to first screening test), confirmatory, subtyping, and adrenalectomy. We included all patients with PA who underwent adrenalectomy from 1st January 2018 to 30th October 2022. After adrenalectomy, patients were evaluated using Primary Aldosteronism Surgery Outcome (PASO) consensus. Patient and center characteristics were compared at the 25th, 50th, and 75th percentiles of TTA using multivariable quantile regression. Multivariable linear regression was used to identify factors associated with longer intervals. Results: Among 708 included patients (mean age 49.2 years, 45.8% female), the overall median TTA was 14.0 months (IQR 7.1-25.2). The median intervals were 0.1 months (screening), 2.3 months (confirmatory), 4.2 months (subtyping), and 5.1 months (adrenalectomy). On multivariable analyses, patients with an additional screening test, an additional AVS, and who presented post-COVID-19 had a significantly longer TTA at the 75th percentile, by 3.2 months, 12.3 months, and 6.0 months respectively. Other factors that increased TTA were younger age, lower baseline diastolic blood pressure (BP) and more baseline BP medications. Factors associated with a longer screening interval included younger age, lower baseline potassium, and lower diastolic BP, while additional screening tests were associated with a longer confirmatory interval. Factors associated with a longer adrenalectomy interval were more baseline BP medications, additional confirmatory tests and additional AVS. Patients who presented post-COVID-19 were associated with longer time at all intervals. Compared to centers that routinely perform AVS, centers without AVS had shorter TTA (6.1 vs 16.5 months, P<0.001), similar PASO clinical outcome, but poorer PASO biochemical outcome, with complete, partial and absent biochemical success seen in 66.4%, 11.9%, 21.6% vs 86.8%, 3.7%, 9.5%, P<0.001, respectively. Conclusion: Based on real-world data from patients with PA managed in five continents, most patients required more than one year from first specialist presentation to adrenalectomy. The longest intervals are time required to undergo AVS and adrenalectomy. While omitting AVS may reduce the TTA, this is associated with poorer biochemical outcome. The COVID-19 pandemic contributed to delayed healthcare delivery worldwide. Presentation: 6/1/2024
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».