Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia

Research output: Contribution to journalArticle

Allyson M. Pishko, Sara Fardin, Daniel S. Lefler, Koosha Paydary, Rolando Vega, Gowthami M. Arepally, Mark Crowther, Lawrence Rice, Douglas B. Cines, Adam Cuker

The HIT Expert Probability (HEP) score compared favorably with the 4Ts score in a retrospective study. We assessed the diagnostic accuracy of the HEP score compared with the 4Ts score in a prospective cohort of 310 patients with suspected heparin-induced thrombocytopenia (HIT). A member of the clinical team calculated the HEP score and 4Ts score. An independent panel adjudicated HIT status based on a clinical summary as well as the results of HIT laboratory testing. The prevalence of HIT in the study population was 14.7%. At a cutoff of $3, the HEP score was 95.3% sensitive (95% confidence interval [CI], 84.2-99.4) and 35.7% specific (95% CI, 29.8-42.0) for HIT. A 4Ts score of $4 had a sensitivity of 97.7% (95% CI, 86.2-99.8) and specificity of 32.9% (95% CI, 27.2-39.1). The areas under the receiver operating characteristic (ROC) curves (AUCs) for the HEP score and 4Ts score were similar (0.81 [95% CI, 0.74-0.87] vs 0.76 [95% CI, 0.69-0.83]; P 5 .12). The HEP score exhibited a significantly higher AUC than the 4Ts score in patients in the intensive care unit (ICU) (0.86 vs 0.79; P 5 .03). Among trainee scorers, the HEP score performed significantly better than the 4Ts score (AUC, 0.80 vs 0.73; P 5 .03). Our data suggest that either the 4Ts score or the HEP score may be used in clinical practice. The HEP score may be preferable in ICU patients and among less experienced clinicians.

Original languageEnglish (US)
Pages (from-to)3155-3162
Number of pages8
JournalBlood Advances
Volume2
Issue number22
DOIs
StatePublished - Nov 27 2018

PMID: 30463915

Altmetrics

Cite this

Standard

Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia. / Pishko, Allyson M.; Fardin, Sara; Lefler, Daniel S.; Paydary, Koosha; Vega, Rolando; Arepally, Gowthami M.; Crowther, Mark; Rice, Lawrence; Cines, Douglas B.; Cuker, Adam.

In: Blood Advances, Vol. 2, No. 22, 27.11.2018, p. 3155-3162.

Research output: Contribution to journalArticle

Harvard

Pishko, AM, Fardin, S, Lefler, DS, Paydary, K, Vega, R, Arepally, GM, Crowther, M, Rice, L, Cines, DB & Cuker, A 2018, 'Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia' Blood Advances, vol. 2, no. 22, pp. 3155-3162. https://doi.org/10.1182/bloodadvances.2018023077

APA

Pishko, A. M., Fardin, S., Lefler, D. S., Paydary, K., Vega, R., Arepally, G. M., ... Cuker, A. (2018). Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia. Blood Advances, 2(22), 3155-3162. https://doi.org/10.1182/bloodadvances.2018023077

Vancouver

Pishko AM, Fardin S, Lefler DS, Paydary K, Vega R, Arepally GM et al. Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia. Blood Advances. 2018 Nov 27;2(22):3155-3162. https://doi.org/10.1182/bloodadvances.2018023077

Author

Pishko, Allyson M. ; Fardin, Sara ; Lefler, Daniel S. ; Paydary, Koosha ; Vega, Rolando ; Arepally, Gowthami M. ; Crowther, Mark ; Rice, Lawrence ; Cines, Douglas B. ; Cuker, Adam. / Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia. In: Blood Advances. 2018 ; Vol. 2, No. 22. pp. 3155-3162.

BibTeX

@article{4eb6b91911c44fffab7c0e44fd647d93,
title = "Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia",
abstract = "The HIT Expert Probability (HEP) score compared favorably with the 4Ts score in a retrospective study. We assessed the diagnostic accuracy of the HEP score compared with the 4Ts score in a prospective cohort of 310 patients with suspected heparin-induced thrombocytopenia (HIT). A member of the clinical team calculated the HEP score and 4Ts score. An independent panel adjudicated HIT status based on a clinical summary as well as the results of HIT laboratory testing. The prevalence of HIT in the study population was 14.7{\%}. At a cutoff of $3, the HEP score was 95.3{\%} sensitive (95{\%} confidence interval [CI], 84.2-99.4) and 35.7{\%} specific (95{\%} CI, 29.8-42.0) for HIT. A 4Ts score of $4 had a sensitivity of 97.7{\%} (95{\%} CI, 86.2-99.8) and specificity of 32.9{\%} (95{\%} CI, 27.2-39.1). The areas under the receiver operating characteristic (ROC) curves (AUCs) for the HEP score and 4Ts score were similar (0.81 [95{\%} CI, 0.74-0.87] vs 0.76 [95{\%} CI, 0.69-0.83]; P 5 .12). The HEP score exhibited a significantly higher AUC than the 4Ts score in patients in the intensive care unit (ICU) (0.86 vs 0.79; P 5 .03). Among trainee scorers, the HEP score performed significantly better than the 4Ts score (AUC, 0.80 vs 0.73; P 5 .03). Our data suggest that either the 4Ts score or the HEP score may be used in clinical practice. The HEP score may be preferable in ICU patients and among less experienced clinicians.",
author = "Pishko, {Allyson M.} and Sara Fardin and Lefler, {Daniel S.} and Koosha Paydary and Rolando Vega and Arepally, {Gowthami M.} and Mark Crowther and Lawrence Rice and Cines, {Douglas B.} and Adam Cuker",
year = "2018",
month = "11",
day = "27",
doi = "10.1182/bloodadvances.2018023077",
language = "English (US)",
volume = "2",
pages = "3155--3162",
journal = "Blood advances",
issn = "2473-9529",
publisher = "American Society of Hematology",
number = "22",

}

RIS

TY - JOUR

T1 - Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia

AU - Pishko, Allyson M.

AU - Fardin, Sara

AU - Lefler, Daniel S.

AU - Paydary, Koosha

AU - Vega, Rolando

AU - Arepally, Gowthami M.

AU - Crowther, Mark

AU - Rice, Lawrence

AU - Cines, Douglas B.

AU - Cuker, Adam

PY - 2018/11/27

Y1 - 2018/11/27

N2 - The HIT Expert Probability (HEP) score compared favorably with the 4Ts score in a retrospective study. We assessed the diagnostic accuracy of the HEP score compared with the 4Ts score in a prospective cohort of 310 patients with suspected heparin-induced thrombocytopenia (HIT). A member of the clinical team calculated the HEP score and 4Ts score. An independent panel adjudicated HIT status based on a clinical summary as well as the results of HIT laboratory testing. The prevalence of HIT in the study population was 14.7%. At a cutoff of $3, the HEP score was 95.3% sensitive (95% confidence interval [CI], 84.2-99.4) and 35.7% specific (95% CI, 29.8-42.0) for HIT. A 4Ts score of $4 had a sensitivity of 97.7% (95% CI, 86.2-99.8) and specificity of 32.9% (95% CI, 27.2-39.1). The areas under the receiver operating characteristic (ROC) curves (AUCs) for the HEP score and 4Ts score were similar (0.81 [95% CI, 0.74-0.87] vs 0.76 [95% CI, 0.69-0.83]; P 5 .12). The HEP score exhibited a significantly higher AUC than the 4Ts score in patients in the intensive care unit (ICU) (0.86 vs 0.79; P 5 .03). Among trainee scorers, the HEP score performed significantly better than the 4Ts score (AUC, 0.80 vs 0.73; P 5 .03). Our data suggest that either the 4Ts score or the HEP score may be used in clinical practice. The HEP score may be preferable in ICU patients and among less experienced clinicians.

AB - The HIT Expert Probability (HEP) score compared favorably with the 4Ts score in a retrospective study. We assessed the diagnostic accuracy of the HEP score compared with the 4Ts score in a prospective cohort of 310 patients with suspected heparin-induced thrombocytopenia (HIT). A member of the clinical team calculated the HEP score and 4Ts score. An independent panel adjudicated HIT status based on a clinical summary as well as the results of HIT laboratory testing. The prevalence of HIT in the study population was 14.7%. At a cutoff of $3, the HEP score was 95.3% sensitive (95% confidence interval [CI], 84.2-99.4) and 35.7% specific (95% CI, 29.8-42.0) for HIT. A 4Ts score of $4 had a sensitivity of 97.7% (95% CI, 86.2-99.8) and specificity of 32.9% (95% CI, 27.2-39.1). The areas under the receiver operating characteristic (ROC) curves (AUCs) for the HEP score and 4Ts score were similar (0.81 [95% CI, 0.74-0.87] vs 0.76 [95% CI, 0.69-0.83]; P 5 .12). The HEP score exhibited a significantly higher AUC than the 4Ts score in patients in the intensive care unit (ICU) (0.86 vs 0.79; P 5 .03). Among trainee scorers, the HEP score performed significantly better than the 4Ts score (AUC, 0.80 vs 0.73; P 5 .03). Our data suggest that either the 4Ts score or the HEP score may be used in clinical practice. The HEP score may be preferable in ICU patients and among less experienced clinicians.

UR - http://www.scopus.com/inward/record.url?scp=85056935760&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056935760&partnerID=8YFLogxK

U2 - 10.1182/bloodadvances.2018023077

DO - 10.1182/bloodadvances.2018023077

M3 - Article

VL - 2

SP - 3155

EP - 3162

JO - Blood advances

T2 - Blood advances

JF - Blood advances

SN - 2473-9529

IS - 22

ER -

ID: 42931374