Heparin-Induced Thrombocytopenia in Patients Suffering Cardiogenic Shock.

Q4 Medicine Critical care explorations Pub Date : 2024-07-22 eCollection Date: 2024-07-01 DOI:10.1097/CCE.0000000000001117
Enzo Lüsebrink, Hugo Lanz, Leonhard Binzenhöfer, Sabine Hoffmann, Julia Höpler, Marie Kraft, Nils Gade, Jonas Gmeiner, Daniel Roden, Inas Saleh, Christian Hagl, Georg Nickenig, Steffen Massberg, Sebastian Zimmer, Raúl Nicolás Jamin, Clemens Scherer
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Abstract

Objectives: Cardiogenic shock (CS) is associated with high mortality. Patients treated for CS mostly require heparin therapy, which may be associated with complications such as heparin-induced thrombocytopenia (HIT). HIT represents a serious condition associated with platelet decline and increased hypercoagulability and remains a poorly researched field in intensive care medicine. Primary purpose of this study was to: 1) determine HIT prevalence in CS, 2) assess the performance of common diagnostic tests for the workup of HIT, and 3) compare outcomes in CS patients with excluded and confirmed HIT.

Design: Retrospective dual-center study including adult patients 18 years old or older with diagnosed CS and suspected HIT from January 2010 to November 2022.

Setting: Cardiac ICU at the Ludwig-Maximilians University hospital in Munich and the university hospital of Bonn.

Patients and interventions: In this retrospective analysis, adult patients with diagnosed CS and suspected HIT were included. Differences in baseline characteristics, mortality, neurologic and safety outcomes between patients with excluded and confirmed HIT were evaluated.

Measurements and main results: In cases of suspected HIT, positive screening antibodies were detected in 159 of 2808 patients (5.7%). HIT was confirmed via positive functional assay in 57 of 2808 patients, corresponding to a prevalence rate of 2.0%. The positive predictive value for anti-platelet factor 4/heparin screening antibodies was 35.8%. Total in-hospital mortality (58.8% vs. 57.9%; p > 0.999), 1-month mortality (47.1% vs. 43.9%; p = 0.781), and 12-month mortality (58.8% vs. 59.6%; p > 0.999) were similar between patients with excluded and confirmed HIT, respectively. Furthermore, no significant difference in neurologic outcome among survivors was found between groups (Cerebral Performance Category [CPC] score 1: 8.8% vs. 8.8%; p > 0.999 and CPC 2: 7.8% vs. 12.3%; p = 0.485).

Conclusions: HIT was a rare complication in CS patients treated with unfractionated heparin and was not associated with increased mortality. Also, HIT confirmation was not associated with worse neurologic outcome in survivors. Future studies should aim at developing more precise, standardized, and cost-effective strategies to diagnose HIT and prevent complications.

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肝素诱导的心源性休克患者血小板减少症。
目的:心源性休克(CS)死亡率很高。治疗心源性休克的患者大多需要肝素治疗,而肝素治疗可能会引起肝素诱导血小板减少症(HIT)等并发症。HIT 是一种与血小板减少和高凝状态增加有关的严重病症,在重症监护医学领域仍是一个研究较少的领域。本研究的主要目的是1)确定 HIT 在重症监护中的发病率;2)评估用于 HIT 检查的常用诊断测试的性能;3)比较排除和确诊 HIT 的重症监护患者的预后:设计:回顾性双中心研究,包括2010年1月至2022年11月期间确诊为CS和疑似HIT的18岁或18岁以上成年患者:慕尼黑路德维希-马克西米利安大学医院和波恩大学医院心脏重症监护室:在这项回顾性分析中,纳入了确诊为CS和疑似HIT的成年患者。评估了排除 HIT 和确诊 HIT 患者在基线特征、死亡率、神经系统和安全结果方面的差异:在疑似 HIT 的病例中,2808 例患者中有 159 例(5.7%)检测到阳性筛查抗体。在 2808 例患者中,有 57 例通过阳性功能测试确诊为 HIT,患病率为 2.0%。抗血小板因子 4/肝素筛查抗体的阳性预测值为 35.8%。排除型和确诊型 HIT 患者的院内总死亡率(58.8% 对 57.9%;P > 0.999)、1 个月死亡率(47.1% 对 43.9%;P = 0.781)和 12 个月死亡率(58.8% 对 59.6%;P > 0.999)分别相似。此外,各组幸存者的神经系统预后无明显差异(脑功能分类 [CPC] 评分 1:8.8% 对 8.8%;P > 0.999;CPC 评分 2:7.8% 对 12.3%;P = 0.485):HIT是接受非分叶肝素治疗的CS患者中罕见的并发症,与死亡率的增加无关。此外,HIT的确认与幸存者神经系统预后的恶化无关。未来的研究应致力于开发更精确、更标准化、更具成本效益的策略来诊断 HIT 并预防并发症。
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