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Utility of ELISA optical density values and clinical scores for the diagnosis of and thrombosis prediction in heparin-induced thrombocytopenia.

Kim SY, Kim HK, Han KS, Kim I, Yoon SS, Park S, Kim BK - Korean J Lab Med (2011)

Bottom Line: Of the 92 patients, 28 were anti-heparin/PF4-seropositive.The 4 T's score and Chong's score showed good correlation (r=0.874).The 4 T's score and OD values showed good performance for diagnosis of the definite and unlikely HIT groups; however, OD levels showed better sensitivity (93.8%) than the 4 T's score used alone (62.5%).

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction caused by antibodies to the heparin/platelet factor 4 (PF4) complex, resulting in thrombocytopenia and prothrombotic state. HIT diagnosis is challenging and depends on clinical presentation and laboratory tests. We investigated the usefulness of clinical scores and heparin/PF4 ELISA optical density (OD) as a diagnostic marker and thrombosis predictor in HIT.

Methods: We analyzed 92 patients with suspected HIT. The heparin/PF4 antibody was measured using a commercial ELISA kit (GTI, USA). For each patient, the 4 T's score and Chong's score were calculated.

Results: Of the 92 patients, 28 were anti-heparin/PF4-seropositive. The 4 T's score and Chong's score showed good correlation (r=0.874). The 4 T's score and OD values showed good performance for diagnosis of the definite and unlikely HIT groups; however, OD levels showed better sensitivity (93.8%) than the 4 T's score used alone (62.5%). Of the 92 patients, 26 developed thrombosis. The OD values were significantly higher in patients with thrombosis than in those without thrombosis (0.52 vs. 0.22, P<0.001). Patients with high OD values (OD>0.4) had an increased risk of thrombosis (adjusted odds ratio 9.44 [3.35-26.6], P<0.001) and a shorter 250-day thrombosis-free survival (32.1% vs. 54.7%, P=0.012).

Conclusions: ELISA OD values in combination with clinical scoring can improve the diagnosis of and thrombosis prediction in HIT. More attention should be paid to the use of clinical scores and OD values as thrombosis predictors in HIT.

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Related in: MedlinePlus

Optical density (OD) values according to (A) the 4 T's and (B) Chong's scoring system. Bars represent median OD level. Uppermost P values were calculated using the Kruskal-Wallis test, and pairwise comparisons were performed using the Dunn test.
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Figure 1: Optical density (OD) values according to (A) the 4 T's and (B) Chong's scoring system. Bars represent median OD level. Uppermost P values were calculated using the Kruskal-Wallis test, and pairwise comparisons were performed using the Dunn test.

Mentions: Heparin/PF4 antibody ELISA OD values according to HIT scoring systems are shown in Fig. 1. The OD was significantly different between the 4 T's category of high, intermediate, and low probability (P<0.001). There was a significant difference between the categories of high versus low and intermediate (P<0.001, P=0.001, respectively: Dunn test) but not between the categories of intermediate and low (P=0.118). The OD was significantly different between Chong's scoring category of definite, probable, possible, and unlikely for HIT (P<0.001). There was significant difference between the categories of definite vs. unlikely, definite vs. possible, and definite vs. probable (P<0.001) but not between the categories of probable vs. possible and possible vs. unlikely (P=1.0).


Utility of ELISA optical density values and clinical scores for the diagnosis of and thrombosis prediction in heparin-induced thrombocytopenia.

Kim SY, Kim HK, Han KS, Kim I, Yoon SS, Park S, Kim BK - Korean J Lab Med (2011)

Optical density (OD) values according to (A) the 4 T's and (B) Chong's scoring system. Bars represent median OD level. Uppermost P values were calculated using the Kruskal-Wallis test, and pairwise comparisons were performed using the Dunn test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3111042&req=5

Figure 1: Optical density (OD) values according to (A) the 4 T's and (B) Chong's scoring system. Bars represent median OD level. Uppermost P values were calculated using the Kruskal-Wallis test, and pairwise comparisons were performed using the Dunn test.
Mentions: Heparin/PF4 antibody ELISA OD values according to HIT scoring systems are shown in Fig. 1. The OD was significantly different between the 4 T's category of high, intermediate, and low probability (P<0.001). There was a significant difference between the categories of high versus low and intermediate (P<0.001, P=0.001, respectively: Dunn test) but not between the categories of intermediate and low (P=0.118). The OD was significantly different between Chong's scoring category of definite, probable, possible, and unlikely for HIT (P<0.001). There was significant difference between the categories of definite vs. unlikely, definite vs. possible, and definite vs. probable (P<0.001) but not between the categories of probable vs. possible and possible vs. unlikely (P=1.0).

Bottom Line: Of the 92 patients, 28 were anti-heparin/PF4-seropositive.The 4 T's score and Chong's score showed good correlation (r=0.874).The 4 T's score and OD values showed good performance for diagnosis of the definite and unlikely HIT groups; however, OD levels showed better sensitivity (93.8%) than the 4 T's score used alone (62.5%).

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction caused by antibodies to the heparin/platelet factor 4 (PF4) complex, resulting in thrombocytopenia and prothrombotic state. HIT diagnosis is challenging and depends on clinical presentation and laboratory tests. We investigated the usefulness of clinical scores and heparin/PF4 ELISA optical density (OD) as a diagnostic marker and thrombosis predictor in HIT.

Methods: We analyzed 92 patients with suspected HIT. The heparin/PF4 antibody was measured using a commercial ELISA kit (GTI, USA). For each patient, the 4 T's score and Chong's score were calculated.

Results: Of the 92 patients, 28 were anti-heparin/PF4-seropositive. The 4 T's score and Chong's score showed good correlation (r=0.874). The 4 T's score and OD values showed good performance for diagnosis of the definite and unlikely HIT groups; however, OD levels showed better sensitivity (93.8%) than the 4 T's score used alone (62.5%). Of the 92 patients, 26 developed thrombosis. The OD values were significantly higher in patients with thrombosis than in those without thrombosis (0.52 vs. 0.22, P<0.001). Patients with high OD values (OD>0.4) had an increased risk of thrombosis (adjusted odds ratio 9.44 [3.35-26.6], P<0.001) and a shorter 250-day thrombosis-free survival (32.1% vs. 54.7%, P=0.012).

Conclusions: ELISA OD values in combination with clinical scoring can improve the diagnosis of and thrombosis prediction in HIT. More attention should be paid to the use of clinical scores and OD values as thrombosis predictors in HIT.

Show MeSH
Related in: MedlinePlus