Key result
A HEP score ≥ 5 demonstrated a sensitivity of 1.00 and specificity of 0.92 for diagnosing HIT in surgical ICU patients, with a significantly higher AUC than the 4Ts score (0.967 vs 0.707; p=0.035).
Why the study?
Heparin-induced thrombocytopenia remains a challenging diagnosis especially in surgical intensive care unit patients, prompting the first evaluation of the diagnostic accuracy of the HIT Expert Probability score in this population.
Does the HEP score improve the early identification of HIT compared to the 4Ts score in surgical critically ill patients?
Observational (n=119)
Blinded outcome assessment
No
Does the HEP score improve the early identification of HIT compared to the 4Ts score in surgical critically ill patients?
Effect estimate: Sensitivity 1.00, Specificity 0.92 (95% CI 0.55-1.00 for sensitivity, 0.86-0.96 for specificity)
The HEP score demonstrates high sensitivity and specificity for diagnosing HIT in surgical ICU patients, significantly outperforming the standard 4Ts score.
May aid early HIT detection in SICU; hypothesis-generating and requires prospective validation before practice change.
Background: Heparin-induced thrombocytopenia (HIT) remains a challenging diagnosis especially in surgical intensive care unit (SICU) patients. The aim of the study was to evaluate for the first time the diagnostic accuracy of the HIT Expert Probability (HEP) score in the early identification of HIT in SICU patients. Methods: The HEP and 4Ts scores were calculated in all patients with suspected HIT during their stay in our SICU. The diagnosis of HIT was finally confirmed (HIT+ group) or excluded (HIT− group) by an independent committee blinded to the HEP and 4Ts score values. The primary outcome was the sensitivity and specificity of a HEP score ≥ 5 for the diagnosis of HIT. The secondary outcome was the area under the ROC curve (AUC) of the HEP and 4Ts scores in the diagnosis of HIT. Results: Respectively 6 and 113 patients were included in the HIT+ and HIT− groups. A HEP score value ≥ 5 had a sensitivity (95% confidence interval (95% CI)) of 1.00 (0.55−1.00), and a specificity (95% CI) of 0.92 (0.86−0.96). The AUC (95% CI) was significantly higher for the HEP score versus for the 4Ts score (0.967 (0.922−1.000) versus 0.707 (0.449−0.965); p = 0.035). Conclusions: A HEP score value < 5 could be helpful to rule out HIT in SICU patients.
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Besch et al. (2022) conducted an observational in Suspected Heparin-induced thrombocytopenia (HIT) (n=119). HIT Expert Probability (HEP) score vs. 4Ts score was evaluated on Sensitivity and specificity of a HEP score ≥ 5 for the diagnosis of HIT (Sensitivity 1.00, Specificity 0.92, 95% CI 0.55-1.00 for sensitivity, 0.86-0.96 for specificity). A HEP score ≥ 5 demonstrated a sensitivity of 1.00 and specificity of 0.92 for diagnosing HIT in surgical ICU patients, with a significantly higher AUC than the 4Ts score (0.967 vs 0.707; p=0.035).
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