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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

Thrombosis-free survival for patients who underwent heparin/PF4 ELISA for detecting the presence of the heparin/PF4 antibody based on the optical density (OD) cut-off of 0.4 (A) and 1.0 (B).
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Figure 4: Thrombosis-free survival for patients who underwent heparin/PF4 ELISA for detecting the presence of the heparin/PF4 antibody based on the optical density (OD) cut-off of 0.4 (A) and 1.0 (B).

Mentions: We compared the overall survival and thrombosis-free survival for all the patients according to the OD cut-offs of 0.4 and 1.0 (Fig. 4). Overall mortality of the patients was 44.6%. The overall survivals (OS) were not different between patients with high OD values (OD>0.4 or OD>1.0) and patients with lower OD values (250-day OS rate for patients with OD>0.4 vs. OD≤0.4: 67.9% vs. 56.3%, P=0.246; OD>1.0 vs. OD≤1.0: 55.6% vs. 60.2, P=0.908). The 250-day thrombosis-free survival rate of patients with OD>0.4 was 32.1%, and that of patients with OD≤0.4 was 54.7% (P=0.012) (Fig. 4A). The 250-day thrombosis-free survival rate of patients with OD>1.0 was also significantly lower than that of the patients with lower OD values (22.2% vs. 50.6%, P=0.003) (Fig. 4B).


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)

Thrombosis-free survival for patients who underwent heparin/PF4 ELISA for detecting the presence of the heparin/PF4 antibody based on the optical density (OD) cut-off of 0.4 (A) and 1.0 (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Thrombosis-free survival for patients who underwent heparin/PF4 ELISA for detecting the presence of the heparin/PF4 antibody based on the optical density (OD) cut-off of 0.4 (A) and 1.0 (B).
Mentions: We compared the overall survival and thrombosis-free survival for all the patients according to the OD cut-offs of 0.4 and 1.0 (Fig. 4). Overall mortality of the patients was 44.6%. The overall survivals (OS) were not different between patients with high OD values (OD>0.4 or OD>1.0) and patients with lower OD values (250-day OS rate for patients with OD>0.4 vs. OD≤0.4: 67.9% vs. 56.3%, P=0.246; OD>1.0 vs. OD≤1.0: 55.6% vs. 60.2, P=0.908). The 250-day thrombosis-free survival rate of patients with OD>0.4 was 32.1%, and that of patients with OD≤0.4 was 54.7% (P=0.012) (Fig. 4A). The 250-day thrombosis-free survival rate of patients with OD>1.0 was also significantly lower than that of the patients with lower OD values (22.2% vs. 50.6%, P=0.003) (Fig. 4B).

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