Predictors of mortality in thrombotic thrombocytopenia after adenoviral COVID-19 vaccination: the FAPIC score.
Por:
Hwang J, Park SH, Lee SW, Lee SB, Lee MH, Jeong GH, Kim MS, Kim JY, Koyanagi A, Jacob L., Jung SY, Song J, Yon DK, Shin JI and Smith L
Publicada:
14 oct 2021
Ahead of Print:
21 sep 2021
Categoría:
Cardiology and cardiovascular medicine
Resumen:
AIMS: The clinical manifestation and outcomes of thrombosis with thrombocytopenia syndrome (TTS) after adenoviral COVID-19 vaccine administration are largely unknown due to the rare nature of the disease. We aimed to analyse the clinical presentation, treatment modalities, outcomes, and prognostic factors of adenoviral TTS, as well as identify predictors for mortality. METHODS AND RESULTS: PubMed, Scopus, Embase, and Web of Science databases were searched and the resulting articles were reviewed. A total of 6 case series and 13 case reports (64 patients) of TTS after ChAdOx1 nCoV-19 vaccination were included. We performed a pooled analysis and developed a novel scoring system to predict mortality. The overall mortality of TTS after ChAdOx1 nCoV-19 vaccination was 35.9% (23/64). In our analysis, age =60 years, platelet count <25 × 103/µL, fibrinogen <150 mg/dL, the presence of intracerebral haemorrhage (ICH), and the presence of cerebral venous thrombosis (CVT) were significantly associated with death and were selected as predictors for mortality (1 point each). We named this novel scoring system FAPIC (fibrinogen, age, platelet count, ICH, and CVT), and the C-statistic for the FAPIC score was 0.837 (95% CI 0.732-0.942). Expected mortality increased with each point increase in the FAPIC score, at 2.08, 6.66, 19.31, 44.54, 72.94, and 90.05% with FAPIC scores 0, 1, 2, 3, 4, and 5, respectively. The FAPIC scoring model was internally validated through cross-validation and bootstrapping, then externally validated on a panel of TTS patients after Ad26.COV2.S administration. CONCLUSIONS: Fibrinogen levels, age, platelet count, and the presence of ICH and CVT were significantly associated with mortality in patients with TTS, and the FAPIC score comprising these risk factors could predict mortality. The FAPIC score could be used in the clinical setting to recognize TTS patients at high risk of adverse outcomes and provide early intensive interventions including intravenous immunoglobulins and non-heparin anticoagulants.
Filiaciones:
Hwang J:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Park SH:
Yonsei University College of Medicine, Seoul, Republic of Korea
Lee SW:
Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
Lee SB:
Ulsan University College of Medicine, Seoul, Republic of Korea
Lee MH:
Yonsei University College of Medicine, Seoul, Republic of Korea
Jeong GH:
College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
Kim MS:
Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
Kim JY:
Yonsei University College of Medicine, Seoul, Republic of Korea
Koyanagi A:
Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
ICREA, Pg. Lluís Companys 23, Barcelona, Spain
Jacob L.:
Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
Jung SY:
Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
Song J:
Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Yon DK:
Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
Shin JI:
Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
Smith L:
The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
Green Accepted, Green Published, Bronze
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