目的:心源性休克(CS)与高死亡率相关。接受CS治疗的患者大多需要肝素治疗,这可能与肝素诱导的血小板减少症(HIT)等并发症有关。HIT代表与血小板下降和高凝性增加相关的严重状况,并且在重症监护医学中仍然是研究很少的领域。这项研究的主要目的是:1)确定CS的HIT患病率,2)评估用于HIT检查的常见诊断测试的性能,和3)比较排除和确认HIT的CS患者的结局。
方法:回顾性双中心研究包括2010年1月至2022年11月18岁或以上确诊为CS和疑似HIT的成年患者。
方法:位于慕尼黑路德维希-马克西米利安大学医院和波恩大学医院的心脏ICU。
方法:在本回顾性分析中,纳入确诊为CS和疑似HIT的成年患者.基线特征的差异,死亡率,对排除和确诊HIT的患者的神经系统和安全性结局进行了评估.
结果:在疑似HIT的病例中,在2808例患者中,有159例(5.7%)的筛查抗体呈阳性.在2808例患者中,有57例通过阳性功能测定证实了HIT,对应于2.0%的患病率。抗血小板因子4/肝素筛查抗体的阳性预测值为35.8%。住院总死亡率(58.8%vs.57.9%;p>0.999),1个月死亡率(47.1%vs.43.9%;p=0.781),和12个月的死亡率(58.8%vs.59.6%;p>0.999)在排除和确认HIT的患者之间相似,分别。此外,两组之间幸存者的神经系统结局没有显着差异(脑功能类别[CPC]评分1:8.8%vs.8.8%;p>0.999,CPC2:7.8%与12.3%;p=0.485)。
结论:HIT是使用普通肝素治疗的CS患者的罕见并发症,与死亡率增加无关。此外,HIT确认与幸存者较差的神经系统预后无关。未来的研究应该旨在开发更精确的,标准化,和具有成本效益的策略来诊断HIT和预防并发症。
OBJECTIVE: 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.
METHODS: Retrospective dual-center study including adult patients 18 years old or older with diagnosed CS and suspected HIT from January 2010 to November 2022.
METHODS: Cardiac ICU at the Ludwig-Maximilians University hospital in Munich and the university hospital of Bonn.
METHODS: 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.
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.