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Abstract：
OBJECTIVE: The accuracy of aldosterone/direct renin concentration ratio (ADRR) as a screening test in patients with primary aldosteronism (PA) varies widely across the studies. Therefore, we conducted a meta-analysis to assess the accuracy of ADRR.
METHODS: A literature search was performed in PubMed, Embase, and the Cochrane library published between April 1971-February 2016. Studies focusing on the accuracy of ADRR for PA screening were included. Two authors independently extracted information regarding patient characteristics, antihypertensives status, true positives, true negatives, false positives, and false negatives. The random-effects model was used for statistical analysis. Heterogeneity was explored by subgroup analysis and meta-regression.
RESULTS: Nine studies involving 974 patients were included. The overall sensitivity, specificity, area under the curve, and diagnostic odds ratio of ADRR were 0.89 (95% confidence interval (CI) 0.84-0.93), 0.96 (95% CI 0.95-0.98), 0.985 and 324 respectively, with substantial heterogeneity. Meta-regression showed that antihypertensive status affects the ADRR and may account for the heterogeneity (p=0.03). Subgroup analysis of patients who discontinued the antihypertensives revealed a sensitivity of 0.99 (95% CI, 0.95-1.00) and a specificity of 0.98 (95% CI, 0.96-0.99).
CONCLUSIONS: This study demonstrates the efficacy of ADRR as a screening test for PA. However, as antihypertensive drugs can interfere with the interpretation of ADRR, it is recommended to interrupt therapy or at least replace with analogues that do not significantly affect the ADRR value.
METHODS: A literature search was performed in PubMed, Embase, and the Cochrane library published between April 1971-February 2016. Studies focusing on the accuracy of ADRR for PA screening were included. Two authors independently extracted information regarding patient characteristics, antihypertensives status, true positives, true negatives, false positives, and false negatives. The random-effects model was used for statistical analysis. Heterogeneity was explored by subgroup analysis and meta-regression.
RESULTS: Nine studies involving 974 patients were included. The overall sensitivity, specificity, area under the curve, and diagnostic odds ratio of ADRR were 0.89 (95% confidence interval (CI) 0.84-0.93), 0.96 (95% CI 0.95-0.98), 0.985 and 324 respectively, with substantial heterogeneity. Meta-regression showed that antihypertensive status affects the ADRR and may account for the heterogeneity (p=0.03). Subgroup analysis of patients who discontinued the antihypertensives revealed a sensitivity of 0.99 (95% CI, 0.95-1.00) and a specificity of 0.98 (95% CI, 0.96-0.99).
CONCLUSIONS: This study demonstrates the efficacy of ADRR as a screening test for PA. However, as antihypertensive drugs can interfere with the interpretation of ADRR, it is recommended to interrupt therapy or at least replace with analogues that do not significantly affect the ADRR value.
摘要：
目的：醛固酮/直接肾素浓度比（ADRR）作为原发性醛固酮增多症（PA）患者筛查测试的准确性在研究中差异很大。因此,我们进行了一项荟萃分析以评估ADRR的准确性.
方法：在PubMed，Embase,和Cochrane图书馆在1971年4月至2016年2月之间出版。包括针对PA筛查的ADRR准确性的研究。两位作者独立提取了有关患者特征的信息，抗高血压药状态，真正的积极因素，真正的底片，假阳性,和假阴性。采用随机效应模型进行统计分析。通过亚组分析和荟萃回归研究异质性。
结果：纳入9项研究，涉及974名患者。整体灵敏度,特异性，曲线下的面积,ADRR的诊断比值比为0.89(95%置信区间(CI)0.84-0.93)，0.96（95%CI0.95-0.98），分别为0.985和324，具有很大的异质性。Meta回归显示，降压状态影响ADRR，并可能解释异质性（p=0.03）。对停用降压药患者的亚组分析显示，敏感性为0.99（95％CI，0.95-1.00），特异性为0.98（95％CI，0.96-0.99）。
结论：本研究证明ADRR作为PA筛查试验的有效性。然而,因为抗高血压药物会干扰ADRR的解释，建议中断治疗或至少替换对ADRR值无显著影响的类似物.
方法：在PubMed，Embase,和Cochrane图书馆在1971年4月至2016年2月之间出版。包括针对PA筛查的ADRR准确性的研究。两位作者独立提取了有关患者特征的信息，抗高血压药状态，真正的积极因素，真正的底片，假阳性,和假阴性。采用随机效应模型进行统计分析。通过亚组分析和荟萃回归研究异质性。
结果：纳入9项研究，涉及974名患者。整体灵敏度,特异性，曲线下的面积,ADRR的诊断比值比为0.89(95%置信区间(CI)0.84-0.93)，0.96（95%CI0.95-0.98），分别为0.985和324，具有很大的异质性。Meta回归显示，降压状态影响ADRR，并可能解释异质性（p=0.03）。对停用降压药患者的亚组分析显示，敏感性为0.99（95％CI，0.95-1.00），特异性为0.98（95％CI，0.96-0.99）。
结论：本研究证明ADRR作为PA筛查试验的有效性。然而,因为抗高血压药物会干扰ADRR的解释，建议中断治疗或至少替换对ADRR值无显著影响的类似物.
