A validation and modification of PLASMIC score by adjusting the criteria of mean corpuscular volume and international normalized ratio.
ADAMTS13
PLASMIC score
international normalized ratio
mean corpuscular volume
thrombocytopenic purpura
Journal
Journal of clinical apheresis
ISSN: 1098-1101
Titre abrégé: J Clin Apher
Pays: United States
ID NLM: 8216305
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
revised:
21
05
2023
received:
03
02
2023
accepted:
31
05
2023
medline:
10
10
2023
pubmed:
16
6
2023
entrez:
16
6
2023
Statut:
ppublish
Résumé
The PLASMIC score was developed for distinguishing thrombotic thrombocytopenic purpura (TTP) from other types of thrombotic microangiopathy. However, two components of the PLASMIC score, mean corpuscular volume (MCV) and international normalized ratio (INR), showed non-significant differences between TTP and non-TTP patients in previous validations. Here, we validate the PLASMIC score and aim to modify it by adjusting the criteria of MCV and INR. A retrospective validation of suspected TTP patients was performed by reviewing electronic medical records from two medical centers in Taiwan. The performance of different modified types of the PLASMIC score was carried out. Among 50 patients included in the final analysis, 12 were diagnosed with TTP based on deficiency of ADAMTS13 activity and clinical judgement. When stratified by high (score ≥ 6) and low-intermediate risk (score < 6), the positive predictive value (PPV) of the PLASMIC score to predict TTP was 0.45 (95% confidence interval [CI]: 0.29-0.61). The area under curve (AUC) was 0.70 (95% CI: 0.56-0.82). When adjusting the criteria of the PLASMIC score from MCV < 90 fL to MCV ≥ 90 fL, the PPV increased to 0.57 (95% CI: 0.37-0.75). The AUC was 0.75 (95% CI: 0.61-0.87). When adjusting the INR from >1.5 to >1.1, the PPV increased to 0.56 (95% CI: 0.39-0.71). The AUC was 0.81 (95% CI: 0.68-0.90). MCV ≥ 90 fL and/or INR > 1.1 might be suitable modifications for PLASMIC score but should be validated in a larger sample size.
Sections du résumé
BACKGROUND
BACKGROUND
The PLASMIC score was developed for distinguishing thrombotic thrombocytopenic purpura (TTP) from other types of thrombotic microangiopathy. However, two components of the PLASMIC score, mean corpuscular volume (MCV) and international normalized ratio (INR), showed non-significant differences between TTP and non-TTP patients in previous validations. Here, we validate the PLASMIC score and aim to modify it by adjusting the criteria of MCV and INR.
MATERIALS AND METHODS
METHODS
A retrospective validation of suspected TTP patients was performed by reviewing electronic medical records from two medical centers in Taiwan. The performance of different modified types of the PLASMIC score was carried out.
RESULTS
RESULTS
Among 50 patients included in the final analysis, 12 were diagnosed with TTP based on deficiency of ADAMTS13 activity and clinical judgement. When stratified by high (score ≥ 6) and low-intermediate risk (score < 6), the positive predictive value (PPV) of the PLASMIC score to predict TTP was 0.45 (95% confidence interval [CI]: 0.29-0.61). The area under curve (AUC) was 0.70 (95% CI: 0.56-0.82). When adjusting the criteria of the PLASMIC score from MCV < 90 fL to MCV ≥ 90 fL, the PPV increased to 0.57 (95% CI: 0.37-0.75). The AUC was 0.75 (95% CI: 0.61-0.87). When adjusting the INR from >1.5 to >1.1, the PPV increased to 0.56 (95% CI: 0.39-0.71). The AUC was 0.81 (95% CI: 0.68-0.90).
CONCLUSION
CONCLUSIONS
MCV ≥ 90 fL and/or INR > 1.1 might be suitable modifications for PLASMIC score but should be validated in a larger sample size.
Substances chimiques
ADAMTS13 Protein
EC 3.4.24.87
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
582-589Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Moschcowitz E. An acute febrile pleiochromic anemia with hyaline thrombosis of the terminal arterioles and capillaries: an undescribed disease. Arch Intern Med. 1925;36(1):89-93.
Amorosi EL, Ultmann JE. Thrombotic thrombocytopenic purpura: report of 16 cases and review of the literature. Medicine. 1966;45(2):139-160.
George JN. How I treat patients with thrombotic thrombocytopenic purpura: 2010. Blood. 2010;116(20):4060-4069.
Moake JL, Rudy CK, Troll JH, et al. Unusually large plasma factor VIII: von Willebrand factor multimers in chronic relapsing thrombotic thrombocytopenic purpura. N Eng J Med. 1982;307(23):1432-1435.
Furlan M, Robles R, Lamie B. Partial purification and characterization of a protease from human plasma cleaving von Willebrand factor to fragments produced by in vivo proteolysis. Blood. 1996;87:4223-4234.
Tsai H-M. Physiologic cleavage of von Willebrand factor by a plasma protease is dependent on its conformation and requires calcium ion. Blood. 1996;87:4235-4244.
Zheng XL. ADAMTS13 and von Willebrand factor in thrombotic thrombocytopenic purpura. Annu Rev Med. 2015;66:211-225.
Zini G, d'Onofrio G, Briggs C, et al. ICSH recommendations for identification, diagnostic value, and quantitation of schistocytes. Int J Lab Hematol. 2012;34(2):107-116.
Favaloro EJ, Pasalic L, Henry B, Lippi G. Laboratory testing for ADAMTS13: utility for TTP diagnosis/exclusion and beyond. Am J Hematol. 2021;96(8):1049-1055.
Bentley M, Wilson A, Rodgers G. Performance of a clinical prediction score for thrombotic thrombocytopenic purpura in an independent cohort. Vox Sang. 2013;105(4):313-318.
Coppo P, Schwarzinger M, Buffet M, et al. Predictive features of severe acquired ADAMTS13 deficiency in idiopathic thrombotic microangiopathies: the French TMA reference center experience. PloS One. 2010;5(4):e10208.
Bendapudi PK, Hurwitz S, Fry A, et al. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study. Lancet Haematol. 2017;4(4):e157-e164.
Bendapudi PK, Li A, Hamdan A, et al. Derivation and prospective validation of a predictive score for the rapid diagnosis of thrombotic thrombocytopenic purpura: the Plasmic score. Blood. 2014;124(21):231.
Oliveira DS, Lima TG, Benevides FLN, et al. Plasmic score applicability for the diagnosis of thrombotic microangiopathy associated with ADAMTS13-acquired deficiency in a developing country. Hematol Transfus Cell Ther. 2019;41(2):119-124.
Wynick C, Britto J, Sawler D, et al. Validation of the PLASMIC score for predicting ADAMTS13 activity <10% in patients with suspected thrombotic thrombocytopenic purpura in Alberta, Canada. Thromb Res. 2020;196:335-339.
Tang N, Wang X, Li D, Sun Z. Validation of the PLASMIC score, a clinical prediction tool for thrombotic thrombocytopenic purpura diagnosis, in Chinese patients. Thromb Res. 2018;172:9-13.
Jajosky R, Floyd M, Thompson T, Shikle J. Validation of the PLASMIC score at a university medical center. Transfus Apher Sci. 2017;56(4):591-594.
Moosavi H, Ma Y, Miller MJ, Duncan A. Validation of PLASMIC score: an academic medical center case series (2012-present). Transfusion. 2020;60(7):1536-1543.
Li A, Khalighi PR, Wu Q, Garcia DA. External validation of the PLASMIC score: a clinical prediction tool for thrombotic thrombocytopenic purpura diagnosis and treatment. J Thromb Haemost. 2018;16(1):164-169.
Tiscia GL, Ostuni A, Cascavilla N, et al. Validation of PLASMIC score and follow-up data in a cohort of patients with suspected microangiopathies from southern Italy. J Thromb Thrombolysis. 2018;46(2):174-179.
Lee CH, Huang YC, Li SS, Hsu YT, Chen YP, Chen TY. Application of PLASMIC score in risk prediction of thrombotic thrombocytopenic purpura: real-world experience from a tertiary medical Center in Taiwan. Front Med. 2022;9:893273.
Paydary K, Banwell E, Tong J, Chen Y, Cuker A. Diagnostic accuracy of the PLASMIC score in patients with suspected thrombotic thrombocytopenic purpura: a systematic review and meta-analysis. Transfusion. 2020;60(9):2047-2057.
Zhao N, Zhou L, Hu X, et al. A modified PLASMIC score including the lactate dehydrogenase/the upper limit of normal ratio more accurately identifies Chinese thrombotic thrombocytopenic purpura patients than the original PLASMIC score. J Clin Apher. 2020;35(2):79-85.
Fage N, Orvain C, Henry N, et al. Proteinuria increases the PLASMIC and French scores performance to predict thrombotic thrombocytopenic purpura in patients with thrombotic Microangiopathy syndrome. Kidney Int Rep. 2022;7(2):221-231.
Bick RL. State-of-the-art review: disseminated intravascular coagulation: objective criteria for clinical and laboratory diagnosis and assessment of therapeutic response. Clin Appl Thromb Hemost. 1995;1(1):3-23.
Zheng XL, Vesely SK, Cataland SR, et al. ISTH guidelines for the diagnosis of thrombotic thrombocytopenic purpura. J Thromb Haemost. 2020;18(10):2486-2495.
Chiasakul T, Cuker A. Clinical and laboratory diagnosis of TTP: an integrated approach. Hematology Am Soc Hematol Educ Program. 2018;2018(1):530-538.
George JN. Measuring ADAMTS13 activity in patients with suspected thrombotic thrombocytopenic purpura: when, how, and why? Transfusion. 2015;55(1):11-13.
Froehlich-Zahnd R, George JN, Vesely SK, et al. Evidence for a role of anti-ADAMTS13 autoantibodies despite normal ADAMTS13 activity in recurrent thrombotic thrombocytopenic purpura. Haematologica. 2012;97(2):297-303.
Chaturvedi S, McCrae KR, Carcioppolo D. Detectable or normal ADAMTS13 activity In patients presenting with thrombotic thrombocytopenic purpura (TTP) is associated with poor renal outcomes. Blood. 2013;122(21):4752.
Sadler JE. What's new in the diagnosis and pathophysiology of thrombotic thrombocytopenic purpura. Hematology Am Soc Hematol Educ Program. 2015;2015(1):631-636.
George JN. The remarkable diversity of thrombotic thrombocytopenic purpura: a perspective. Blood Adv. 2018;2(12):1510-1516.
Ehsanipoor RM, Rajan P, Holcombe RF, Wing DA. Limitations of ADAMTS-13 activity level in diagnosing thrombotic thrombocytopenic purpura in pregnancy. Clin Appl Thromb Hemost. 2009;15(5):585-587.
Tiscia GL, Grandone E. PLASMIC score: not intended to replace but rather to prompt the ADAMTS13 testing. Transfusion. 2020;60(12):3070-3072.
Maner BS, Moosavi L. Mean corpuscular volume. Treasure Island (FL): StatPearls Publishing; 2019.
Beutler E, West C. Hematologic differences between African-Americans and whites: the roles of iron deficiency and α-thalassemia on hemoglobin levels and mean corpuscular volume. Blood. 2005;106(2):740-745.
Lin CK, Lee SH, Wang CC, Jiang ML, Hsu HC. Alpha-thalassemic traits are common in the Taiwanese population: usefulness of a modified hemoglobin H preparation for prevalence studies. J Lab Clin Med. 1991;118(6):599-603.
Ko TM, Hsu PM, Chen CJ, Hsieh FJ, Hsieh CY, Lee TY. Incidence study of heterozygous beta-thalassemia in northern Taiwan. Taiwan yi xue hui za zhi. J Formos Med Assoc. 1989;88(7):678-681.
Lee HW, Han SM, Yang Y, et al. Thalassemia phenotypes and genotypes in Taiwan: a retrospective study based on thalassemia screening of young men for military conscription. Hemoglobin. 2015;39(3):173-177.
Blann A, Bareford D. Ethnic background is a determinant of average warfarin dose required to maintain the INR between 3.0 and 4.5. J Thromb Haemost. 2004;2(3):525-526.
Lee LH, Kong MC, Teo I, et al. Optimal international normalized ratio range for Asian patients on anticoagulation therapy. Blood. 2017;130(suppl 1):3719.
Shen AY-J, Chen W, Yao JF, Brar SS, Wang X, Go AS. Effect of race/ethnicity on the efficacy of warfarin. CNS Drugs. 2008;22(10):815-825.
Shen AY-J, Yao JF, Brar SS, Jorgensen MB, Chen W. Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation. J Am Coll Cardiol. 2007;50(4):309-315.