Re-evaluation of the optimal cutoff of saline infusion test in the diagnosis of primary aldosteronism
10.3760/cma.j.issn.1000-6699.2018.06.003
- VernacularTitle:生理盐水试验确诊原发性醛固酮增多症的最佳切点再评价
- Author:
Xiuyong YANG
1
;
Ying SONG
;
Wenwen HE
;
Mei MEI
;
Qingfeng CHENG
;
Shumin YANG
;
Jinbo HU
;
Zhipeng DU
;
Jian LONG
;
Qianna ZHEN
;
Qifu LI
Author Information
1. 遵义市第一人民医院内分泌科
- Keywords:
Primary aldosteronism;
Saline infusion test;
Sensitivity;
Specificity
- From:Chinese Journal of Endocrinology and Metabolism
2018;34(6):460-465
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the diagnostic value of saline infusion test ( SIT) and its optimal cutoff in the diagnosis of primary aldosteronism ( PA ), and to analyze whether the dietary salt intake affects the SIT accuracy. Methods This is a prospective study. All 236 patients with a high risk for PA underwent the screening test, SIT and the fludrocortisone suppression test (FST) in separate days. The diagnosis of PA was established according to the FST criteria. According to the 24 h urinary sodium level, the patients were divided into low salt, normal salt, and high salt groups respectively, and the effect of salt intake on SIT was analyzed. Receiver operating characteristic (ROC) analysis was performed to compare the diagnostic accuracies. Results Finally, in 236 patients with high risk for PA, 134 patients with PA and 102 patients with essential hypertension ( EH) were diagnosed. Using post-test plasma aldosterone concentration (PAC) for diagnosis, the area under the ROC curve (AUCROC) of the SIT was 0.974 (0.957, 0.991), which was significantly higher than that of the post-test plasma aldosterone to renin ratio (ARR) [0.900 ( 0. 862, 0. 938)] and that of the PAC suppression percentage [ 0. 752 ( 0. 690, 0. 813)] ( both P<0.01). Considering both sensitivity and specificity, an optimal cutoff of PAC post-SIT was set at 8 ng/dl, resulting in a sensitivity of 88. 1% and a specificity of 95. 1%. The PAC post-SIT, whether in PA or EH patients, had no statistically significant differences among low salt, normal salt, and high salt groups (P>0.05). Conclusion SIT is reliable for the diagnosis of PA. PAC post-SIT more than 8.0 ng/dl is recommended to confirm PA.
