Multivariable Model to Predict an ACTH Stimulation Test to Diagnose Adrenal Insufficiency Using Previous Test Results
© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society..
Context: The adrenocorticotropin hormone stimulation test (AST) is used to diagnose adrenal insufficiency, and is often repeated in patients when monitoring recovery of the hypothalamo-pituitary-adrenal axis.
Objective: To develop and validate a prediction model that uses previous AST results with new baseline cortisol to predict the result of a new AST.
Methods: This was a retrospective, longitudinal cohort study in patients who had undergone at least 2 ASTs, using polynomial regression with backwards variable selection, at a Tertiary UK adult endocrinology center. Model was developed from 258 paired ASTs over 5 years in 175 adults (mean age 52.4 years, SD 16.4), then validated on data from 111 patients over 1 year (51.8, 17.5) from the same center, data collected after model development. Candidate prediction variables included previous test baseline adrenocorticotropin hormone (ACTH), previous test baseline and 30-minute cortisol, days between tests, and new baseline ACTH and cortisol used with calculated cortisol/ACTH ratios to assess 8 candidate predictors. The main outcome measure was a new test cortisol measured 30 minutes after Synacthen administration.
Results: Using 258 sequential ASTs from 175 patients for model development and 111 patient tests for model validation, previous baseline cortisol, previous 30-minute cortisol and new baseline cortisol were superior at predicting new 30-minute cortisol (R2 = 0.71 [0.49-0.93], area under the curve [AUC] = 0.97 [0.94-1.0]) than new baseline cortisol alone (R2 = 0.53 [0.22-0.84], AUC = 0.88 [0.81-0.95]).
Conclusion: Results of a previous AST can be objectively combined with new early-morning cortisol to predict the results of a new AST better than new early-morning cortisol alone. An online calculator is available at https://endocrinology.shinyapps.io/sheffield_sst_calculator/ for external validation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:7 |
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| Enthalten in: |
Journal of the Endocrine Society - 7(2023), 12 vom: 02. Nov., Seite bvad127 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lawrence, Neil Richard [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal insufficiency |
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| Anmerkungen: |
Date Revised 05.12.2023 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1210/jendso/bvad127 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364340290 |
|---|
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| 100 | 1 | |a Lawrence, Neil Richard |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Multivariable Model to Predict an ACTH Stimulation Test to Diagnose Adrenal Insufficiency Using Previous Test Results |
| 264 | 1 | |c 2023 | |
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| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. | ||
| 520 | |a Context: The adrenocorticotropin hormone stimulation test (AST) is used to diagnose adrenal insufficiency, and is often repeated in patients when monitoring recovery of the hypothalamo-pituitary-adrenal axis | ||
| 520 | |a Objective: To develop and validate a prediction model that uses previous AST results with new baseline cortisol to predict the result of a new AST | ||
| 520 | |a Methods: This was a retrospective, longitudinal cohort study in patients who had undergone at least 2 ASTs, using polynomial regression with backwards variable selection, at a Tertiary UK adult endocrinology center. Model was developed from 258 paired ASTs over 5 years in 175 adults (mean age 52.4 years, SD 16.4), then validated on data from 111 patients over 1 year (51.8, 17.5) from the same center, data collected after model development. Candidate prediction variables included previous test baseline adrenocorticotropin hormone (ACTH), previous test baseline and 30-minute cortisol, days between tests, and new baseline ACTH and cortisol used with calculated cortisol/ACTH ratios to assess 8 candidate predictors. The main outcome measure was a new test cortisol measured 30 minutes after Synacthen administration | ||
| 520 | |a Results: Using 258 sequential ASTs from 175 patients for model development and 111 patient tests for model validation, previous baseline cortisol, previous 30-minute cortisol and new baseline cortisol were superior at predicting new 30-minute cortisol (R2 = 0.71 [0.49-0.93], area under the curve [AUC] = 0.97 [0.94-1.0]) than new baseline cortisol alone (R2 = 0.53 [0.22-0.84], AUC = 0.88 [0.81-0.95]) | ||
| 520 | |a Conclusion: Results of a previous AST can be objectively combined with new early-morning cortisol to predict the results of a new AST better than new early-morning cortisol alone. An online calculator is available at https://endocrinology.shinyapps.io/sheffield_sst_calculator/ for external validation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a adrenal insufficiency | |
| 650 | 4 | |a adrenocorticotropin stimulation test | |
| 650 | 4 | |a cortisol | |
| 650 | 4 | |a predictive model | |
| 650 | 4 | |a short Synacthen test | |
| 700 | 1 | |a Arshad, Muhammad Fahad |e verfasserin |4 aut | |
| 700 | 1 | |a Pofi, Riccardo |e verfasserin |4 aut | |
| 700 | 1 | |a Ashby, Sean |e verfasserin |4 aut | |
| 700 | 1 | |a Dawson, Jeremy |e verfasserin |4 aut | |
| 700 | 1 | |a Tomlinson, Jeremy W |e verfasserin |4 aut | |
| 700 | 1 | |a Newell-Price, John |e verfasserin |4 aut | |
| 700 | 1 | |a Ross, Richard J |e verfasserin |4 aut | |
| 700 | 1 | |a Elder, Charlotte J |e verfasserin |4 aut | |
| 700 | 1 | |a Debono, Miguel |e verfasserin |4 aut | |
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