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Improved prediction of HIT in the SICU using an improved model of the Warkentin 4-T System: 3-T

Bloom, Matthew B. and Johnson, Jeffrey and Volod, Oksana and Lee, Ernest Y. and White, Terris and Margulies, Daniel R. (2020) Improved prediction of HIT in the SICU using an improved model of the Warkentin 4-T System: 3-T. American Journal of Surgery, 219 (1). pp. 54-57. ISSN 0002-9610.

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Background: The Warkentin 4-T scoring system for determining the pretest probability of heparin-induced thrombocytopenia (HIT) has been shown to be inaccurate in the ICU and does not take into account body mass index (BMI). Methods: Prospectively collected data on patients in the surgical and cardiac ICU between January 2007 and February 2016 who were presumed to have HIT by clinical suspicion were reviewed. Patients were categorized into 3 BMI groups and assigned scores: Normal weight, overweight, and obese. Multivariate analyses were used to identify independent predictors of HIT. Results: A total of 523 patients met inclusion criteria. Multivariate analysis showed that only BMI, Timing, and oTher variables were independently associated with HIT. This new 3-T model was better than a five-component model consisting of the entire 4-T scoring system plus BMI (AUC = 0.791). Conclusions: Incorporating patient ‘T’hickness into a pretest probability model along with platelet ‘T’iming and the exclusion of o‘T’her causes of thrombocytopenia yields a simplified “3-T” scoring system that has increased predictive accuracy in the ICU.

Item Type:Article
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Lee, Ernest Y.0000-0001-5144-2552
Additional Information:© 2019 Published by Elsevier Inc. Received 4 May 2019, Revised 18 July 2019, Accepted 27 July 2019, Available online 29 July 2019. E.Y.L. acknowledges support from the Medical Scientist Training Program at UCLA (T32GM008042). The authors declare no conflicts of interest. The authors have no relevant disclosures.
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NIH Predoctoral FellowshipT32GM008042
Issue or Number:1
Record Number:CaltechAUTHORS:20190729-151920830
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Official Citation:Matthew B. Bloom, Jeffrey Johnson, Oksana Volod, Ernest Y. Lee, Terris White, Daniel R. Margulies, Improved prediction of HIT in the SICU using an improved model of the Warkentin 4-T system: 3-T, The American Journal of Surgery, Volume 219, Issue 1, 2020, Pages 54-57, ISSN 0002-9610, (
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:97495
Deposited By: Tony Diaz
Deposited On:30 Jul 2019 15:51
Last Modified:17 Dec 2019 18:56

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