Performance of Diagnostic Scores in Thrombotic Microangiopathy Patients in the Intensive Care Unit: A Monocentric Study

Eric Mariotte; Lara Zafrani; Jehane Fadlallah; Lionel Galicier; Etienne Ghrenassia; Lionel Kerhuel; Laure Calvet; Audrey De Jong; Virginie Lemiale; Sandrine Valade; Bérangère S. Joly; Alain Stepanian; Elie Azoulay; Michael Darmon

doi:10.1055/a-1378-3804

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2021; 121(11): 1427-1434
DOI: 10.1055/a-1378-3804

Cellular Haemostasis and Platelets

Performance of Diagnostic Scores in Thrombotic Microangiopathy Patients in the Intensive Care Unit: A Monocentric Study

Eric Mariotte

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

,

Lara Zafrani

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

²UFR Médecine, Université de Paris, Paris, France

,

Jehane Fadlallah

²UFR Médecine, Université de Paris, Paris, France

³Département d'Immunopathologie, Hôpital Saint-Louis, APHP, Paris, France

,

Lionel Galicier

³Département d'Immunopathologie, Hôpital Saint-Louis, APHP, Paris, France

,

Etienne Ghrenassia

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

²UFR Médecine, Université de Paris, Paris, France

,

Lionel Kerhuel

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

²UFR Médecine, Université de Paris, Paris, France

,

Laure Calvet

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

,

Audrey De Jong

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

,

Virginie Lemiale

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

,

Sandrine Valade

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

,

Bérangère S. Joly

²UFR Médecine, Université de Paris, Paris, France

⁴Service d'Hématologie Biologique, Hôpital Lariboisière, APHP, Paris, France

,

Alain Stepanian

²UFR Médecine, Université de Paris, Paris, France

⁴Service d'Hématologie Biologique, Hôpital Lariboisière, APHP, Paris, France

,

Elie Azoulay

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

²UFR Médecine, Université de Paris, Paris, France

⁵UMR1153, Équipe ECSTRRA, INSERM, Université Paris Diderot, Paris, France

,

Michael Darmon

¹Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France

²UFR Médecine, Université de Paris, Paris, France

⁵UMR1153, Équipe ECSTRRA, INSERM, Université Paris Diderot, Paris, France

› Author Affiliations

Abstract

Early thrombotic thrombocytopenic purpura (TTP) recognition is critical as this disease is almost always lethal if not treated promptly with therapeutic plasma exchanges. Currently, as ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity is not widely available in emergency, scores have been developed to help differentiating TTP from other thrombotic microangiopathies (TMAs). The aim of this work was to study the accuracy of these diagnostic scores in the intensive care unit (ICU) setting. Performance of both Coppo and PLASMIC scores was studied in a cohort of adult TMA patients requiring admission to one university hospital ICU from 2006 to 2017. Receiver operating characteristic (ROC) curves were established, and confidence intervals of the area under the curve (AUC) were determined. Multivariate logistic regression analysis was performed to identify parameters specifically associated with TTP, to compare diagnostic scores and to elaborate more accurate diagnostic models. During the study period, 154 TMA patients required ICU admission, including 99 (64.2%) TTP and 55 (35.7%) non-TTP patients. AUC under the ROC curve in predicting TTP was 0.86 (95% confidence interval [CI]: 0.81–0.92) for the Coppo score, 0.67 (95% CI: 0.58–0.76) for the PLASMIC score, and 0.86 (95% CI: 0.81–0.92) for platelet count alone. Platelet count ≤20 G/L, determined as the best cut-off rate for thrombocytopenia, performed similarly to the Coppo score and better than the PLASMIC score to differentiate TTP from non-TTP patients, both using AUC ROC curve and logistic regression. In a monocentric cohort of TMA patients requiring ICU admission, the PLASMIC score had limited performance for the diagnosis of TTP. The performance of the Coppo score was good but similar to a single highly discriminant item: platelet count ≤20 G/L at admission.

Keywords

diagnostic scores - thrombotic microangiopathy - thrombotic thrombocytopenic purpura

Full Text

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Supplementary Material

Supplementary Material