Reduced sensitivity of PLASMIC and French scores for the diagnosis of thrombotic thrombocytopenic purpura in older individuals.
Reduced sensitivity of PLASMIC and French scores for the diagnosis of thrombotic thrombocytopenic purpura in older individuals.
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DOI：
10.1111/trf.16188
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发表时间：
2021-01
期刊：
影响因子：
2.9
通讯作者：
Chaturvedi S
中科院分区：
文献类型：
--
作者：
Liu A;Dhaliwal N;Upreti H;Kasmani J;Dane K;Moliterno A;Braunstein E;Brodsky R;Chaturvedi S
血栓性血小板减少性紫癜（TTP）是一种罕见的，潜在的致命性血液系统疾病的特点是血小板减少，微血管病性溶血性贫血，缺血性器官损害。PLASMIC和French TTP评分有助于快速识别TTP，并在无法进行确证性ADAMTS 13检测时指导临床决策。然而，年龄可能会影响这些工具的风险分层，因为老年人血细胞减少的严重程度较低，肾损害的发生率较高。研究年龄对PLASMIC和French评分诊断效用的影响。我们计算PLASMIC ≥5和French评分≥1检测不同年龄血栓性微血管病（TMA）患者TTP的敏感性和特异性。在81例TTP和76例其他TMA患者中，PLASMIC评分的诊断效用随年龄增长而下降，18-39岁、40-59岁和≥60岁的敏感性分别为91.4%、78.3%和76.9%，特异性分别为60.0%、33.3%和50%。同样，对于French评分，这些年龄组的敏感性分别为100.0%、96.2%和76.9%，特异性分别为64.0%、35.3%和40.0%。与最年轻的年龄组相比，≥60岁的患者的血小板计数显著较高（35.1±8.6 vs 19.9±2.8 ×109/L，p=0.031），PLASMIC评分较低（5.15±1.34 vs 5.97±0.18，p=0.031）。PLASMIC和French TTP评分在年龄≥60岁时的敏感性和特异性较低，在识别老年患者的TTP时可能不太可靠。需要高度怀疑和ADAMTS 13快速检测的可用性，以正确诊断所有TTP患者，尤其是老年人。
Thrombotic thrombocytopenic purpura (TTP) is a rare, potentially fatal hematologic disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, and ischemic organ impairment. The PLASMIC and French TTP scores facilitate rapid recognition of TTP and guide clinical decisions when confirmatory ADAMTS13 testing is not available. However, age may impact risk stratification of these tools as older individuals present with less severe cytopenias and higher rates of renal impairment. To investigate the impact of age on the diagnostic utility of the PLASMIC and French scores. We calculated the sensitivity and specificity of PLASMIC ≥5 and French score ≥1 in detecting TTP among patients with a thrombotic microangiopathy (TMA) for different ages. Among 81 patients with TTP and 76 with another TMA, diagnostic utility of the PLASMIC score decreased with age, with sensitivities of 91.4%, 78.3%, and 76.9% and specificities of 60.0%, 33.3%, and 50% for ages 18–39, 40–59, and ≥60 years old, respectively. Similarly, for the French score, sensitivities were 100.0%, 96.2%, and 76.9% and specificities were 64.0%, 35.3%, and 40.0% for those age groups. Patients ≥60 years old had significantly higher platelet counts (35.1±8.6 vs 19.9±2.8 ×109/L, p=0.031) and lower PLASMIC scores (5.15±1.34 vs 5.97±0.18, p=0.031) compared to the youngest age group. The PLASMIC and French TTP scores have lower sensitivities and specificities at ages ≥60 years old, and may be less reliable in identifying TTP in older patients. A high index of suspicion and availability of rapid ADAMTS13 assays is required to correctly diagnose all patients with TTP, especially the elderly.
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影响因子：
24.7
作者：
Bendapudi, Pavan K.;Hurwitz, Shelley;Makar, Robert S.
通讯作者：
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DOI：
10.1182/asheducation-2018.1.539
发表时间：
2018-11-01
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3
作者：
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影响因子：
2.9
作者：
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影响因子：
12.8
作者：
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通讯作者：
McCrae, Keith R.
DOI：
10.1016/j.lpm.2011.10.025
发表时间：
2012-03-01
期刊：
Presse medicale (Paris, France : 1983)
影响因子：
--
作者：
Mannucci, Pier Mannuccio;Franchini, Massimo
通讯作者：
Franchini, Massimo