Body mass index strongly impacts the diagnosis and incidence of heparin-induced thrombocytopenia in the surgical intensive care unit

Autor: Rex Chung, Russell Mason, Daniel R. Margulies, Matthew B. Bloom, Andrea A. Zaw, Oksana Volod, David M. Hoang, Nicolas Melo, Rodrigo F. Alban, Eric J. Ley
Rok vydání: 2016
Předmět:
Male
Serotonin
medicine.medical_specialty
Enzyme-Linked Immunosorbent Assay
030204 cardiovascular system & hematology
Platelet Factor 4
Critical Care and Intensive Care Medicine
Body Mass Index
law.invention
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
law
Thromboembolism
Heparin-induced thrombocytopenia
Internal medicine
medicine
Humans
030212 general & internal medicine
Retrospective Studies
Heparin
business.industry
Incidence
Incidence (epidemiology)
Anticoagulants
Odds ratio
Middle Aged
Prognosis
medicine.disease
Thrombocytopenia
Intensive care unit
United States
Confidence interval
Antibodies
Anti-Idiotypic
Surgery
Survival Rate
Pre- and post-test probability
Intensive Care Units
Surgical Procedures
Operative
Coronary care unit
Female
business
Body mass index
Biomarkers
Follow-Up Studies
Zdroj: Journal of Trauma and Acute Care Surgery. 80:398-404
ISSN: 2163-0755
DOI: 10.1097/ta.0000000000000952
Popis: BACKGROUND The obese state has been linked to several immune-mediated conditions. Our objective was to examine the association of body mass index (BMI) with the diagnosis of heparin-induced thrombocytopenia (HIT). METHODS Prospectively collected data on patients in the surgical and cardiac intensive care unit suspected of having HIT between January 2007 and August 2014 were analyzed. Patients were categorized into five discrete BMI (kg/m) groups and compared. Data collected included Warkentin 4-T scores, antiplatelet factor 4 (anti-PF4OD) values, serotonin release assay values, and thromboembolic diseases. HIT positivity was defined as serotonin release assay value greater than 20%. RESULTS Of 304 patients meeting inclusion criteria, mean (SD) age was 62.1 (16.5) years, 59% were male, and mean (SD) BMI was 27 (6) kg/m. Thirty-six (12%) were positive for HIT. Incidence of HIT increased progressively with BMI (0%, 8%, 11%, 19%, 36%; p < 0.001). Compared with patients with normal BMI, patients with a BMI of 30 kg/m to 39.9 kg/m had a 200% increase in the odds for HIT (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.20-7.54; p = 0.019), while patients with a BMI of 40 kg/m or greater had a 600% increase (OR, 6.98; 95% CI, 1.59-28.2; p = 0.012). After regression analysis, BMI remained an independent predictor of the development of HIT (adjusted OR per kg/m, 1.08; 95% CI, 1.02-1.14; p = 0.010). Anti-PF4OD values greater than or equal to 2.0 also increased with BMI (p < 0.001). In-hospital mortality increased significantly with BMI above normal (p = 0.026). Warkentin 4-T scores, deep venous thrombosis, pulmonary embolism, and stroke incidence did not correlate with changes in BMI. CONCLUSION Increasing BMI seems to be strongly associated with increased rates of HIT in intensive care unit patients. Obesity is an important new clinical variable for estimating the pretest probability of HIT, and patient "thickness" could be considered a fifth "T" of the 4-T scoring system. Additional biochemical work is indicated to decipher the role of obesity in this immune-mediated condition. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.
Databáze: OpenAIRE
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