Department of Pharmacy, University of North Carolina Medical Center, 101 Manning Drive, Chapel Hill, NC, USA.
Translational and Clinical Sciences Institute, University of North Carolina, 160 Medical Drive, Chapel Hill, NC, USA.
J Crit Care. 2022 Feb;67:88-94. doi: 10.1016/j.jcrc.2021.09.012. Epub 2021 Nov 1.
Thrombocytopenia is common among critically ill patients and heparin-induced thrombocytopenia (HIT) is often on the differential. Professional guidelines recommend calculating a pre-test probability score before performing HIT testing. The 4Ts score is widely utilized but accuracy has been questioned in critically ill patients. The HIT Expert Probability (HEP) score is available, but complexity limits use. Our objective was to compare a modified intensive care unit (ICU)-4Ts score to available scoring tools.
This was a single-center retrospective pilot study. Adult ICU patients that were tested for HIT and had a documented 4Ts score were included. A blinded investigator retrospectively calculated the HEP and ICU-4Ts score. Receiver operating characteristics (ROC) area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared.
In 194 included patients, ROC AUC was significantly higher for the ICU-4Ts compared to the 4Ts score (0.80 versus 0.66, respectively; p = 0.044). The ICU-4Ts score had the highest specificity, PPV, and NPV. The sensitivity was similar between the HEP and ICU-4Ts score.
The ICU-4Ts score better predicted the diagnosis of HIT compared to the 4Ts score. Prospective validation studies are needed to confirm these results.
血小板减少症在危重症患者中很常见，肝素诱导的血小板减少症（HIT）通常需要进行鉴别诊断。专业指南建议在进行 HIT 检测前计算检测前概率评分。4Ts 评分被广泛应用，但在危重症患者中的准确性受到质疑。HIT 专家概率（HEP）评分也已存在，但由于其复杂性限制了其应用。我们的目的是比较改良的重症监护病房（ICU）-4Ts 评分与现有评分工具。
这是一项单中心回顾性试点研究。纳入接受 HIT 检测且有记录的 4Ts 评分的成年 ICU 患者。一名经过培训的调查员对 HEP 和 ICU-4Ts 评分进行了回顾性计算。比较了受试者工作特征（ROC）曲线下面积（AUC）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在 194 例纳入患者中，与 4Ts 评分相比，ICU-4Ts 评分的 ROC AUC 显著更高（分别为 0.80 和 0.66，p=0.044）。与其他评分相比，ICU-4Ts 评分具有最高的特异性、PPV 和 NPV。HEP 和 ICU-4Ts 评分的敏感性相似。
与 4Ts 评分相比，ICU-4Ts 评分能更好地预测 HIT 的诊断。需要进行前瞻性验证研究来证实这些结果。
