Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis
Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis
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DOI：
10.1182/blood-2012-07-443051
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发表时间：
2012-11-15
期刊：
影响因子：
20.3
通讯作者：
Warkentin, Theodore E.
中科院分区：
文献类型：
--
作者：
Cuker, Adam;Gimotty, Phyllis A.;Warkentin, Theodore E.
4 Ts是肝素诱导的血小板减少症（HIT）的试验前临床评分系统。虽然广泛用于临床实践，但其在不同环境和患者人群中对HIT的预测价值尚不清楚。我们进行了系统回顾和荟萃分析，以评估4 T在疑似HIT患者中的预测价值。我们检索了PubMed、科克伦数据库和ISI Web of Science，以查找包括疑似HIT患者的研究，这些患者通过4 T和可与4 T进行比较的参考标准进行评价。合格研究的质量通过QUADAS-2标准进行评估。13项研究共涉及3068例患者，符合入选标准。共有1712例（55.8%）患者按4 Ts评分分类为HIT概率较低。低概率4 Ts评分的阴性预测值为0.998（95% CI，0.970-1.000），并且无论负责评分的一方、HIT的患病率或研究人群的组成如何，阴性预测值都保持较高。中概率和高概率4 Ts评分的阳性预测值分别为0.14（0.09-0.22）和0.64（0.40-0.82）。低概率4 Ts评分似乎是排除HIT的可靠方法。具有中等和高概率评分的患者需要进一步评估。（血。2012; 120（20）：4160-4167）
The 4Ts is a pretest clinical scoring system for heparin-induced thrombocytopenia (HIT). Although widely used in clinical practice, its predictive value for HIT in diverse settings and patient populations is unknown. We performed a systematic review and meta-analysis to estimate the predictive value of the 4Ts in patients with suspected HIT. We searched PubMed, Cochrane Database, and ISI Web of Science for studies that included patients with suspected HIT, who were evaluated by both the 4Ts and a reference standard against which the 4Ts could be compared. Quality of eligible studies was assessed by QUADAS-2 criteria. Thirteen studies, collectively involving 3068 patients, fulfilled eligibility criteria. A total of 1712 (55.8%) patients were classified by 4Ts score as having a low probability of HIT. The negative predictive value of a low probability 4Ts score was 0.998 (95% CI, 0.970-1.000) and remained high irrespective of the party responsible for scoring, the prevalence of HIT, or the composition of the study population. The positive predictive value of an intermediate and high probability 4Ts score was 0.14 (0.09-0.22) and 0.64 (0.40-0.82), respectively. A low probability 4Ts score appears to be a robust means of excluding HIT. Patients with intermediate and high probability scores require further evaluation. (Blood. 2012; 120(20): 4160-4167)