A New Clinical Model to Estimate the Pre-Test Probability of Cushing's Syndrome: The Cushing Score.
Front Endocrinol (Lausanne)
; 12: 747549, 2021.
Article
in English
| MEDLINE | ID: covidwho-1488429
ABSTRACT
Background:
Hypercortisolism accounts for relevant morbidity and mortality and is often a diagnostic challenge for clinicians. A prompt diagnosis is necessary to treat Cushing's syndrome as early as possible.Objective:
The aim of this study was to develop and validate a clinical model for the estimation of pre-test probability of hypercortisolism in an at-risk population.Design:
We conducted a retrospective multicenter case-control study, involving five Italian referral centers for Endocrinology (Turin, Messina, Naples, Padua and Rome). One hundred and fifty patients affected by Cushing's syndrome and 300 patients in which hypercortisolism was excluded were enrolled. All patients were evaluated, according to current guidelines, for the suspicion of hypercortisolism.Results:
The Cushing score was built by multivariable logistic regression, considering all main features associated with a clinical suspicion of hypercortisolism as possible predictors. A stepwise backward selection algorithm was used (final model AUC=0.873), then an internal validation was performed through ten-fold cross-validation. Final estimation of the model performance showed an average AUC=0.841, thus reassuring about a small overfitting effect. The retrieved score was structured on a 17.5-point scale low-risk class (score value ≤5.5, probability of disease=0.8%); intermediate-low-risk class (score value 6-8.5, probability of disease=2.7%); intermediate-high-risk class (score value 9-11.5, probability of disease=18.5%) and finally, high-risk class (score value ≥12, probability of disease=72.5%).Conclusions:
We developed and internally validated a simple tool to determine pre-test probability of hypercortisolism, the Cushing score, that showed a remarkable predictive power for the discrimination between subjects with and without a final diagnosis of Cushing's syndrome.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Models, Statistical
/
Cushing Syndrome
Type of study:
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
English
Journal:
Front Endocrinol (Lausanne)
Year:
2021
Document Type:
Article
Affiliation country:
Fendo.2021.747549
Similar
MEDLINE
...
LILACS
LIS