A differentiated approach to assess the diagnostic usefulness of a rapid particle gel immunoassay for the detection of antibodies against heparin-platelet factor 4 in cardiac surgery patients
| Autor: | Andreas R. Huber, Lorenz Risch, Ingmar A. F. M. Heijnen, Wolfgang Bertschmann |
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| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.drug_class Platelet Factor 4 Gastroenterology Sensitivity and Specificity law.invention Postoperative Complications law Predictive Value of Tests Internal medicine Cardiopulmonary bypass Medicine Humans Prospective Studies Prospective cohort study Aged Autoantibodies Immunoassay medicine.diagnostic_test business.industry Heparin Cardiovascular Surgical Procedures Anticoagulant Thrombosis Hematology General Medicine Middle Aged medicine.disease Surgery Cardiac surgery Predictive value of tests Female business Gels Platelet factor 4 |
| Zdroj: | Blood coagulationfibrinolysis : an international journal in haemostasis and thrombosis. 14(1) |
| ISSN: | 0957-5235 |
| Popis: | Enzyme-linked immunosorbent assay (ELISA) methods have shown to be of a low specificity for confirming heparin-induced thrombocytopenia (HIT) in cardiac surgery patients. In other patient collectives, a new antigen test [ID-HPF4 Particle Gel Immuno Assay (PaGIA); Diamed, Cressier sur Morat, Switzerland] was recently reported to exhibit a better specificity than the ELISA. Since a more specific test would serve as a useful tool when diagnosing HIT, a prospective study was carried out to elucidate the specificity and diagnostic usefulness of PaGIA in cardiac surgical patients. As assessed in cardiac surgery patients without HIT, the proportion of PaGIA-positive samples was lowest at baseline (16%; 13/74), increasing to 31% (19/61) at postoperative days 5-9 (P = 0.06) and 69% (29/42) at postoperative days 10-18 (P < 0.001 versus postoperative days 5-9). The respective proportions in an ELISA (HPF4 ELISA; Stago, Asnieres sur Seine, France) were lower. Because the prevalence of antibody positivity increases during the postoperative course, a differentiated mathematical model was used to assess predictive values and likelihood ratios (LR) of the PaGIA at three different phases of hospitalization. Calculating LR revealed -LR to be 0.07 at baseline, 0.09 during postoperative days 5-9, and 0.19 during postoperative days 10-18, while +LR were 5.9 at baseline, 3.0 during postoperative days 5-9, and 1.4 during postoperative days 10-18. Thus, in cardiac surgery patients, the PaGIA can be regarded as a useful tool in excluding rapid onset and typical onset of HIT, and further provides valuable information in the confirmation of rapid onset of HIT. Using a differentiated approach for calculation of predictive values and LR, the present study demonstrates that PaGIA, despite a lower specificity than the employed ELISA, in some situations is a valuable tool when diagnosing HIT in cardiac surgery patients. |
| Databáze: | OpenAIRE |
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