Novel FAPIC score can predict mortality in TTE after COVID-19 vaccination: Study
South Korea: Results from a recent study suggest that a combination of laboratory, demographic, and clinical markers may predict mortality in thrombosis with thrombocytopenia syndrome (TTS) patients. This may help in the identification of high-risk patients in the clinical setting. The study, published in the European Heart Journal, is the first to identify risk factors for mortality and propose a novel FAPIC (fibrinogen, age, platelet count, ICH, and CVT) score for predicting mortality in TTS patients.
In simpler words, fibrinogen levels, age, platelet count, and the presence of intracerebral hemorrhage (ICH) and cerebral venous thrombosis (CVT) were significantly associated with mortality in TTS patients. FAPIC score that comprised of these factors could predict mortality. This indicates the utility of the FAPIC score in clinical settings to recognize TTS patients at high risk of adverse outcomes and provide early intensive interventions including non-heparin anticoagulants and intravenous immunoglobulins.
The clinical manifestation and outcomes of TTS after the administration of the adenoviral COVID-19 vaccine are largely unknown owing to the rare nature of the disease. Dong Keon Yon, Seoul National University College of Medicine, Seoul, South Korea, and colleagues aimed to analyze the clinical presentation, treatment modalities, outcomes, and prognostic factors of adenoviral TTS, as well as identify predictors for mortality.
For this purpose, the researchers searched the online databases 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. A novel scoring system was developed to predict mortality by performing a pooled analysis.
Key findings include:
- The overall mortality of TTS after ChAdOx1 nCoV-19 vaccination was 35.9% (23/64).
- In the 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). This novel scoring system was named FAPIC (fibrinogen, age, platelet count, ICH, and CVT), and the C-statistic for the FAPIC score was 0.837.
- 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.
"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," wrote the authors.
Reference:
Jimin Hwang, Seung Hyun Park, Seung Won Lee, Se Bee Lee, Min Ho Lee, Gwang Hun Jeong, Min Seo Kim, Jong Yeob Kim, Ai Koyanagi, Louis Jacob, Se Yong Jung, Jaewoo Song, Dong Keon Yon, Jae Il Shin, Lee Smith, Predictors of mortality in thrombotic thrombocytopenia after adenoviral COVID-19 vaccination: the FAPIC score, European Heart Journal, Volume 42, Issue 39, 14 October 2021, Pages 4053–4063, https://doi.org/10.1093/eurheartj/ehab592
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