Development and validation of a novel diagnostic nomogram model to predict primary aldosteronism in patients with hypertension

Primary aldosteronism (PA) remains, to a large extent, an under-diagnosed disease. We aimed to develop and validate a novel clinical nomogram to predict PA based on routine biochemical variables including new ones, calcium-phosphorus product. Records from 806 patients with hypertension were randomly divided into 70% (n = 564) as the training set and the remaining 30% (n = 242) as the validation set. Predictors for PA were extracted to construct a nomogram model based on regression analysis of the training set. An internal validation was performed to assess the nomogram model’s discrimination and consistency using the area under the curve for receiver operating characteristic curves and calibration plots. The diagnostic accuracy was compared between nomogram and other known prediction models, using receiver operating characteristics (ROC) and decision curve analyses (DCA). Female gender, serum potassium, serum calcium-phosphorus product, and urine pH were adopted as predictors in the nomogram. The nomogram resulted in an area under the curve of 0.73 (95% confidence interval: 0.68–0.78) in the training set and an area under the curve of 0.68 (0.59–0.75) in the validation set. Predicted probability and actual probability matched well in the nomogram (p > 0.05). Based on ROC and DCA, 21–70% threshold to predict PA in the nomogram model was clinically useful. We have developed a novel nomogram to predict PA in hypertensive individuals based on routine biochemical variables. External validation is needed to further demonstrate its predictive ability in primary care settings.