Performance evaluation of scoring systems for predicting post-operative hypertension cure in primary aldosteronism.

OBJECTIVE: Hypertension cure following adrenalectomy in unilateral primary aldosteronism is not guaranteed. Its likelihood is associated with pre-operative parameters, which have been variably combined in six different predictive scoring systems. The relative performance of these systems is currently unknown. The objective of this work was to identify the best performing scoring system for predicting hypertension cure following adrenalectomy for primary aldosteronism. DESIGN: Retrospective analysis in a single tertiary referral centre. PATIENTS: Eighty-seven adult patients with unilateral primary aldosteronism who had undergone adrenalectomy between 2004 and 2018 for whom complete data sets were available to calculate all scoring systems. MEASUREMENTS: Prediction of hypertension cure by each of the six scoring systems. RESULTS: Hypertension cure was achieved in 36/87 (41.4%) patients within the first post-operative year, which fell to 18/71 (25.4%) patients at final follow-up (median 53 months, P = .002). Analysis of receiver operating characteristic area under the curves for the different scoring systems identified a difference in performance at early, but not late, follow-up. For all systems, the area under the curve was lower at early compared with late follow-up and compared to performance in the cohorts in which they were originally defined. CONCLUSIONS: No single scoring system performed significantly better than all others when applied in our cohort, although two did display particular advantages. It remains to be determined how best such scoring systems can be incorporated into the routine clinical care of patients with PA.

The burden of alcohol misuse on the emergency department.

This study had two objectives. To assess the impact of alcohol-related problems on the Emergency Department (ED) of Cork University Hospital (CUH). To assess the non-acute impact of alcohol-related problems on CUH. One hundred patient ED records were chosen at random from each of three study periods--December 23rd 2002 to January 2nd 2003, April 20th 2003 to April 30th 2003, and December 23rd 2003 to January 2nd 2004. Each patient record was examined individually to determine the rate of alcohol-related attendances at CUH ED. Overall, alcohol related attendances accounted for 14.66% of ED attendances. 22.73% of these patients were admitted and 27.27% received an out-patient department appointment. The results of this study were broadly in keeping with previous large-scale studies; it is clear that alcohol-related attendances, admissions and OPD appointments are putting a large strain on EDs and the whole hospital system.