Predictors of mortality in thrombotic thrombocytopenia after adenoviral COVID-19 vaccination: the FAPIC score
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- Jimin Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
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- Seung Hyun Park
- Yonsei University College of Medicine , Seoul, Republic of Korea
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- Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence , Seoul, South Korea
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- Se Bee Lee
- Ulsan University College of Medicine , Seoul, Republic of Korea
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- Min Ho Lee
- Yonsei University College of Medicine , Seoul, Republic of Korea
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- Gwang Hun Jeong
- College of Medicine, Gyeongsang National University , Jinju, Republic of Korea
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- Min Seo Kim
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University , Samsung Medical Center, Seoul, Republic of Korea
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- Jong Yeob Kim
- Yonsei University College of Medicine , Seoul, Republic of Korea
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- Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat , Barcelona, Spain
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- Louis Jacob
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat , Barcelona, Spain
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- Se Yong Jung
- Department of Pediatrics, Yonsei University College of Medicine , Seoul, Republic of Korea
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- Jaewoo Song
- Department of Laboratory Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea
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- Dong Keon Yon
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, South Korea
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- Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine , Seoul, Republic of Korea
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- Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University , Cambridge, UK
Description
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec>
Journal
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- European Heart Journal
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European Heart Journal 42 (39), 4053-4063, 2021-09-21
Oxford University Press (OUP)
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Details 詳細情報について
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- CRID
- 1360294645471602688
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- ISSN
- 15229645
- 0195668X
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- Data Source
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- Crossref