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Assessment of a modified 4T scoring system for heparin-induced thrombocytopenia in critically ill patients.
[heparin-induced thrombocytopenia]
The
purpose
of
the
study
is
to
determine
if
a
modified
4
T
(
m
4
T
)
scoring
system
,
which
omits
clinical
evaluation
of
other
thrombocytopenic
etiologies
,
is
different
from
the
4
T
scoring
system
's
probability
to
predict
a
positive
heparin-induced
thrombocytopenia
(
HIT
)
laboratory
test
in
the
intensive
care
unit
.
This
is
a
single
-centered
retrospective
analysis
of
critically
ill
adults
who
had
an
enzyme-linked
immunosorbent
assay
antiplatelet
factor
4
antibody
(
ELISA
anti-
PF
4
Ab
)
ordered
.
Patients
were
identified
as
HIT
positive
(
optical
density
,
≥
0
.
40
)
or
HIT
negative
(
optical
density
,
<
0
.
40
)
based
on
the
ELISA
anti-
PF
4
Ab
.
Both
4
T
and
m
4
T
scores
were
calculated
,
and
the
diagnostic
accuracy
was
compared
using
paired
receiver
operating
characteristic
curves
.
A
total
of
1487
adult
intensive
care
unit
patients
with
an
ELISA
anti-
PF
4
Ab
ordered
between
January
2007
and
December
2009
were
eligible
for
study
enrollment
.
Application
of
exclusion
criteria
and
random
selection
yielded
a
total
of
232
patients
included
for
analysis
(
58
HIT
-
positive
and
174
HIT
-negative
patients
)
.
The
area
under
the
curve
for
the
4
T
and
m
4
T
scores
were
0
.
683
(
95
%
confidence
interval
,
0
.
604
-
0
.
762
)
and
0
.
680
(
95
%
confidence
interval
,
0
.
600
-
0
.
759
)
,
respectively
(
P
=
.
065
)
.
This
study
does
not
show
a
difference
in
the
probability
of
the
m
4
T
and
4
T
scoring
systems
to
predict
a
positive
ELISA
anti-
PF
4
Ab
test
in
the
critically
ill
patient
population
.
Further
prospective
studies
are
needed
to
validate
the
m
4
T
scoring
system
.
Diseases
Validation
Diseases presenting
"critically ill adults"
symptom
heparin-induced thrombocytopenia
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