The Combination of the Lactate Dehydrogenase/Hemoglobin Ratio with the PLASMIC Score Facilitates Differentiation of TTP from Septic DIC Without Identification of Schistocytes

Autor: Nobushiro Nishimura MD, Kiyomi Yoshimoto MD, PhD, Noritaka Yada MD, PhD, Ayaka Kakiwaki MD, Akihiro Sawa MD, Satoshi Senzaki MD, Hiromasa Kawashima MD, Ryo Yoneima MD, Shiro Ono MD, PhD, Kazuya Sakai MD, PhD, Masanori Matsumoto MD, PhD, Hidetada Fukushima MD, PhD, Kenji Nishio MD, PhD
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Clinical and Applied Thrombosis/Hemostasis, Vol 29 (2023)
Druh dokumentu: article
ISSN: 1938-2723
10760296
DOI: 10.1177/10760296231207629
Popis: In some cases, differentiating thrombotic thrombocytopenic purpura (TTP) from septic disseminated intravascular coagulation (DIC) without measuring ADAMTS13 activity is critical for urgent lifesaving plasma exchange. To investigate whether PLASMIC score without identifying the presence of schistocytes, D-dimer, fibrin/fibrinogen degradation products (FDP), FDP/D-dimer ratio, prothrombin time-international normalized ratio (PT-INR), lactate dehydrogenase (LD), hemoglobin (Hb), and LD/Hb ratio are useful in differentiating patients with TTP from those with septic DIC. Retrospective analysis was conducted on the medical records of the patients with septic DIC (32 patients) or TTP (16 patients). The PLASMIC score and other laboratory measurements all were helpful in differentiating TTP from septic DIC. When dichotomized between high risk (scores 6–7) and intermediate–low risk (scores 0–5), the PLASMIC score predicted TTP with a sensitivity of 75.0% and a specificity of 100%. However, 4 of 16 patients with TTP and 19 of 32 patients with septic DIC showed comparable PLASMIC scores of 4 or 5, making it difficult to distinguish between the two by PLASMIC score alone. Among the measurements examined, the LDH/Hb ratio was the most useful for differentiation. Receiver operating characteristic analysis of the LD/Hb ratio for predicting TTP revealed a cutoff of 53.7 (IU/10 g) (sensitivity 0.94, specificity 0.91). If the LD/Hb ratio was less than 53.7, it was unlikely that the patient had TTP. A combination of the LD/Hb ratio and the PLASMIC score may be useful for distinguishing between TTP and DIC and identifying patients who need rapid plasma exchange or caplacizumab administration.
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