The Predictive Value of the 4Ts and HEP Score at Recommended Cutoffs in Patients With Mechanical Circulatory Support Devices.

Autor: Kram SJ; Department of Pharmacy, Duke University Hospital, Durham, NC. Electronic address: shawn.kram@duke.edu., Hamidi A; Department of Pharmacy, Rush University Medical Center, Chicago, IL., Kram BL; Department of Pharmacy, Duke University Hospital, Durham, NC., Arepally G; Department of Hematology, Duke University Hospital, Durham, NC., Levy JH; Departments of Anesthesiology and Surgery (Cardiothoracic), Duke University Hospital, Durham, NC.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2022 Jul; Vol. 36 (7), pp. 1873-1879. Date of Electronic Publication: 2022 Feb 26.
DOI: 10.1053/j.jvca.2022.02.030
Abstrakt: Objectives: Despite the increasing utilization of mechanical circulatory support (MCS) devices, the 4Ts and heparin-induced thrombocytopenia (HIT) Expert Probability (HEP) scores have not been validated in patients with suspected HIT requiring MCS.
Design: A retrospective cohort study.
Setting: At a tertiary university hospital.
Participants: Adults with suspected HIT requiring any MCS.
Interventions: A diagnostic investigation of HIT.
Measurements and Main Results: Of the 299 patients included, there were 374 diagnostic investigations of HIT, of which 32 (8.6%) were HIT-probable (heparin PF4 immunoassay optical density ≥1 or positive serotonin release assay). The 4Ts score ≥4 demonstrated a pretest sensitivity of 0.56 (95% confidence interval [CI]: 0.39-0.72) and specificity of 0.8 (95% CI: 0.75-0.83). The HEP score ≥3 demonstrated a pretest sensitivity of 0.31 (95% CI: 0.18-0.49) and specificity of 0.83 (95% CI: 0.79-0.87). The area under the receiver operating characteristic curve for the 4Ts and HEP scores were 0.68 (95% CI: 0.63-0.73) and 0.63 (95% CI: 0.59-0.68), respectively, and were not statistically different (p = 0.21). In patients with an intra-aortic balloon pump, neither the 4Ts nor HEP score had discriminatory ability to differentiate probable HIT. The HEP score had no discriminatory ability in patients with concomitant MCS devices.
Conclusions: The 4Ts and HEP scores have a modest predictive performance for probable HIT in patients requiring MCS devices. A low 4Ts or HEP score does not reliably rule out HIT in patients requiring MCS, and clinical suspicion for HIT should be investigated, utilizing laboratory tests in this population.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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