A validation and modification of PLASMIC score by adjusting the criteria of mean corpuscular volume and international normalized ratio

IF 1.4 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis Pub Date : 2023-06-16 DOI:10.1002/jca.22068

Jia-Arng Lee MD, MSc, Mei-Hwa Lin BS, Chun-Min Kang MD, Ming-Kai Chuang MD, Chi Kwan Boris Fung MD, Shyh-Chyi Lo MD, PhD

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引用次数: 0

Abstract

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

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

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

MCV ≥ 90 fL and/or INR > 1.1 might be suitable modifications for PLASMIC score but should be validated in a larger sample size.

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通过调整平均红细胞体积和国际标准化比率的标准来验证和修改血浆评分。

背景：血浆评分用于区分血栓性血小板减少性紫癜（TTP）和其他类型的血栓性微血管病。然而，血浆评分的两个组成部分，平均红细胞体积（MCV）和国际标准化比值（INR），在先前的验证中显示TTP和非TTP患者之间没有显著差异。在此，我们验证血浆评分，并通过调整MCV和INR的标准来修改它。材料和方法：通过审查台湾两个医疗中心的电子医疗记录，对疑似TTP患者进行回顾性验证。进行了不同改良类型的等离子体评分的性能。结果：在纳入最终分析的50例患者中，根据ADAMTS13活性缺乏和临床判断，12例被诊断为TTP。按高（分数）分层时 ≥ 6）和中低风险（得分 1.5至>1.1时，PPV增加至0.56（95%CI:0.39-0.71）。AUC为0.81（95%CI:0.68-0.90）。结论：MCV ≥ 90 fL和/或INR > 1.1可能是血浆评分的合适修改，但应在更大的样本量中进行验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Apheresis 医学-血液学

CiteScore

2.80

自引率

13.30%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Clinical Apheresis publishes articles dealing with all aspects of hemapheresis. Articles welcomed for review include those reporting basic research and clinical applications of therapeutic plasma exchange, therapeutic cytapheresis, therapeutic absorption, blood component collection and transfusion, donor recruitment and safety, administration of hemapheresis centers, and innovative applications of hemapheresis technology. Experimental studies, clinical trials, case reports, and concise reviews will be welcomed.