52 2017 1 1 42 1 ARR [ ] /(PAC/PRA ARR) ( ) 1992 2014 451 300 (EH) (ROC)ARR ARR EH (P<0.01) (PRA) (BMI) EH (P<0.01)(P>0.05) EH PRA (P>0.05) ARR 19.11(AUC) 0.968 92.44% 93.08% (YI) 0.86ARR 27.26 AUC 0.956 92.07% 90.00% YI 0.82 ARR YI ARRARR [ ] [ ] R586.24 [ ] A [ ] 0577-7402(2017)01-0052-05 [DOI] 10.11855/j.issn.0577-7402.2017.01.10 Effects of gender on screening value of aldosterone-renin ratio for primary aldosteronism SONG Ye-qiong 1, WANG Lin 1,2, ZHU Jie 1, JIA Xiao-meng 1, PANG Ping 1, JIN Nan 1, ZANG Li 1, YANG Guo-qing 1, GU Wei-jun 1, DU Jin 1, WANG Xian-ling 1, GUO Qing-hua 1, YANG Li-juan 1, LV Zhao-hui 1*, BA Jian-ming 1, DOU Jing-tao 1, MU Yi-ming 1 1 Department of Endocrinology, General Hospital of PLA, Beijing 100853, China 2 Department of First Internal Medicine, 316 Hospital of PLA, Beijing 100093 China * Corresponding author, Email:metabolism301@126.com [Abstract] Objective To explore the potential influence of gender on screening value of aldosterone-renin ratio (ARR) for primary aldosteronism (PA). Methods The biochemical parameters were collected of 451 PA patients and 300 essential hypertension (EH) patients who were diagnosed in the General Hospital of PLA from 1992 to 2014. Each group was then divided into two groups by gender. The clinical characteristics were compared and then the receiver operating characteristic curve (ROC) was conducted to evaluate the best cut-off value. Results The plasma aldosterone concentration (PAC), serum sodium and ARR were much higher, but the plasma rennin activity (PRA), serum potassium and BMI were much lower in PA patients than in EH patients (P<0.01), and no significant difference existed between the two groups in age, duration of hypertension and blood pressure. The PRA was obviously lower in males than in females either in PA or in EH patients, but no significant difference existed between males and females in PAC (P>0.05). The best cut-off value of ARR in male PA patients was 19.11, the relevant area under the curve (AUC) was 0.968, the sensitivity and specificity was 92.44% and 93.08%, and the Youden index (YI) was 0.86. The best cut-off value of ARR in female PA patients was 27.26, with AUC 0.956, sensitivity 92.07%, specificity 90.00% and YI 0.82, respectively. If the cut-off value was set at 27.26 in males, the specificity would rise a little, but the sensitivity and YI would sharply decrease. Similarly, the sensitivity would increase a little but the specificity and YI would fall substantially if the cut-off value in females was set at 19.11. The best cut-off value of ARR in men was smaller than the official value recommended by guidelines. Conclusion Gender is an important factor should be considered while ARR is used in PA screening, and the cut-off value of ARR in screening female PA patients should be setting higher. [Key words] hyperaldosteronism; sex factor; posture [ ]- - [ ] 100853 ( ) 100093 316 ( ) [ ] E-mail metabolism301@126.com
Med J Chin PLA, Vol. 42, No. 1, January 1, 2017 53 ( ) (low plasma renin activity PRA) [1] 5%~13% 20% [2] / (plasma aldosterone concentration/plasma renin activity PAC/PRA ARR) Hiramatsu [3] 1981 ARR [4-8] ARR 50 <50 [9] 1992 2014 451 300 (essential hypertension EH) ARR 1 1.1 1992 2014 451 1/2 ( ) 352 99 EH 3 140/90mmHg EH 300 1.2 4 2 2 8:00am PRA 4h PRA [10] 10% 15% PRA<0.79 g/(l h) <7.14 g/(l h) 0.93~6.56 g/(l h) 1.13~9.68 g/(l h) PAC 163.4~481.9pmol/L 337.9~1022.1pmol/L 180.1~819.9pmol/L 383.0~1758.9pmol/L 1.3 SPSS 19.0 MedCalc 15.10 x±s M(Q 25 Q 75 ) t χ 2 (receive operate curve ROC) P<0.05 2 2.1 EH ARREH (P<0.01) PRA (BMI) EH (P<0.01) EH (P<0.01) (P>0.05 1) 2.2 EH (47.1± 11.1 vs 45.1± 10.3 P<0.05) BMI EH (44.9± 14.1 vs 50.1± 12.6 P<0.05) BMIEH PRA (P>0.05) ARR (P<0.01 2) 2.3 ARR/ ARR 25.45 19.11 27.26 ROC (AUC) (YI)(+LR) (-LR) 0.961 90.93% 91.64% 0.83 10.88 0.10 0.968 92.44% 93.08% 0.86 13.6 0.08 0.956 92.07% 90.00% 0.82 9.21 0.09( 1 3) Kappa Kappa 0.85 0.83(P<0.01) 2.4 ARR
54 2017 1 1 42 1 1 EH Tab.1 Comparison of clinical data and biochemical parameters between PA and EH patients Item PA EH P value Age (year) a 46.07± 10.74 47.33± 13.65 0.117 Male/Female 225/226 160/140 <0.01 Supine PRA [ng/(ml.h)] b 0.1(0.1, 0.1) 0.7(0.3, 1.7) <0.01 Supine PAC (pmol/l) b 604.10(467.93, 775.02) 395.25(306.15, 487.74) <0.01 Supine ARR (ng/dl)/[ng/(ml.h)] b 185.99(118.23, 263.51) 21.09(8.56, 48.91) <0.01 Upright PRA [ng/(ml.h)] b 0.2(0.1,0.5) 4.1(1.7, 7.6) <0.01 Upright PAC (pmol/l) b 719.60(537.63, 928.13) 566.40(446.90, 698.90) <0.01 Upright ARR(ng/dl)/[ng/(ml.h)] b 119.51(49.42, 251.44) 5.40(2.91, 11.90) <0.01 Duration of hypertension (year) b 9(4, 13) 5(1, 11) 0.611 SBP (mmhg) b 160(144.5, 180) 170(100, 120) 0.302 DBP (mmhg) b 100(90, 110) 110(100, 120) 0.143 Serum potassium (mol/l) a 2.83± 0.56(1.31, 4.71) 3.75± 0.45(1.90, 4.75) <0.01 Serum sodium (mol/l) a 144.52± 2.39 143.05± 2.14 <0.01 BMI (kg/m 2 ) b 24.95(22.83, 27.18) 26.60(23.90, 29.00) <0.01 PA. Primary aldosteronism; EH. Essential hypertension; PRA. Plasma renin activity; PAC. Plasma aldosterone concentration; ARR. Plasma aldosterone concentration/plasma renin activity; SBP. Systolic blood pressure; DBP. Diastolic blood pressure; BMI. Body mass index. a. Expressed by x±s (min, max); b. Expressed by M (Q 25,Q 75 ); 1ng/dl=27.7pmol/L 2 EH Tab.2 Clinical data and biochemical parameters of different gender patients with PA or EH Item PA EH Male Female Male Female Age (year) 47.07± 11.08 45.09± 10.33 (1) 44.92± 14.10 50.09± 12.61 (1) Supine PRA [ng/(ml h)] 0.1(0.1, 0.2) 0.1(0.1, 0.1) (1) 1.0(0.3, 2.2) 0.6(0.2, 1.3) (1) Supine PAC (pmol/l) 567.30(454.35, 776.40) 622.10(475.90, 773.10) 427.55(330.70, 540.43) 365.15(281.88, 452.90) (2) Supine ARR (ng/dl)/[ng/(ml.h)] 179.00(111.87, 257.80) 195.99(128.66, 268.45) 16.14(7.42, 42.55) 26.18(9.62, 57.85) (1) Upright PRA [ng/(ml h)] 0.2(0.1, 0.5) 0.1(0.1, 0.4) (1) 4.70(2.0, 8.8) 3.15(1.30, 6.25) (2) Upright PAC (pmol/l) 710.30(534.95, 927.90) 728.60(542.10, 936.60) 583.1(451.1, 717.1) 555.25(444.90, 698.90) Upright ARR (ng/dl)/[ng/(ml.h)] 104.77(43.12, 219.58) 135.20(56.85, 286.71) (2) 4.4(2.68, 8.96) 7.7(3.2, 16.41) (2) Duration of hypertension (year) 10(5, 14.5) 8.5(3.38, 13) 5(1, 10) 5(2, 11) SBP (mmhg) 160(145, 180) 160(142, 180) 160(145.25, 180) 159(140.5, 171.5) DBP (mmhg) 100(90, 111.5) 100(90, 110) 100(90, 111) 92.5(93.84, 100) (2) Serum potassium (mol/l) 2.82± 0.53 2.81± 0.58 3.72± 0.49 3.77± 0.40 Serum sodium (mol/l) 145.03± 2.40 143.93± 2.24 (1) 143.16± 2.22 142.94± 2.04 BMI (kg/m 2 ) 26.10(24.10, 28.20) 24.10(22.08, 25.75) (2) 27.30(24.80, 29.70) 25.30(23.20, 27.60) (2) (1)P<0.05, (2)P<0.01 compared with male; 1ng/dl=27.7pmol/L 1.0 Male 1.0 Female 0.8 0.8 Sensitivity 0.6 0.4 Sensitivity 0.6 0.4 0.2 0.2 0 0 0.2 0.4 0.6 0.8 1.0 1-Sepcificity A 1 (A) (B) ROC Fig.1 The ROC curve for diagnosing primary aldosteronism in males (A) and females (B) 0 0 0.2 0.4 0.6 0.8 1.0 1-Sepcificity B
Med J Chin PLA, Vol. 42, No. 1, January 1, 2017 55 3 ARR ROC Tab.3 ROC characteristics of screening PA patients by using ARR in each gender group Gender AUC 95%CI Best cut-off value Sensitivity Specificity YI +LR -LR Male 0.968 0.945-0.983 19.11 92.44 93.08 0.86 13.6 0.08 Female 0.956 0.930-0.975 27.26 92.07 90.00 0.82 9.21 0.09 Total 0.961 0.945-0.974 25.45 90.93 91.64 0.83 10.88 0.10 AUC. The area under ROC curve; 95%CI. 95% confidence interval; YI. Youden index; +LR. Positive likehood ratio; -LR. Negative likehood ratio ARR 25.45ng/dl 27.26ng/dl ( 92.44% 88.10% 87.80%)( 93.08% 94.30% 94.34%) YI ( 0.855 0.824 0.821) ARR 19.11ng/dl 25.45ng/dl ( 92.07% 95.59% 93.40%) ( 90.0% 81.50% 87.10%) ( 0.821 0.771 0.805) ( 4) 4 ARR Tab.4 Diagnostic value of different ARR cut-off values for screeningpapatientsineachgendergroup Gender Cut-off value Sensitivity Specifity YI +LR -LR 19.11 92.44 93.08 0.855 13.56 0.08 Male 25.45 88.10 94.30 0.824 15.46 0.13 27.26 87.80 94.34 0.821 15.51 0.13 19.11 95.59 81.50 0.771 5.17 0.05 Female 25.45 93.40 87.10 0.805 7.24 0.08 27.26 92.07 90.00 0.821 9.21 0.09 YI. Youden index; +LR. Positive likehood ratio; -LR. Negative likehood ratio 3 Hiramatsu [3] ARR( / ) 10 [11] [4-8] 1992 2014 451 300 EH EH PRA ARR ARR [6-7] ARR Ahmed [12] ARR PRA PRA ARR PRA James [13] 9 PRA 27% Kaplan [14] 127 363 EH PRA PRA ARR PRA EH James [13] Pizzolo [7] Miller [15] PRA ARR James [13] 2823 ARR( PRA ) ARR [16] 71 82 ARRARR 56.25(10.73~115.39) 96.88(47.92~180.55) ARR James [13] [16] ARRARR ARR ( ) 20~40(ng/dl)/[ng/(ml.h)]
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