Development and internal validation of a clinical prediction model for the diagnosis of immune thrombocytopenia

被引：7

作者：

Li, Na ^{[1
,2
]}

Mahamad, Syed ^{[1
]}

Parpia, Sameer ^{[2
]}

Iorio, Alfonso ^{[3
]}

Foroutan, Farid ^{[3
]}

Heddle, Nancy M. ^{[1
,4
]}

Hsia, Cyrus C. ^{[5
]}

Sholzberg, Michelle ^{[6
,7
,8
]}

Rimmer, Emily ^{[9
,10
]}

Shivakumar, Sudeep ^{[11
]}

Sun, Haowei ^{[12
]}

Refaei, Mohammad ^{[13
]}

Hamm, Caroline ^{[14
,15
]}

Arnold, Donald M. ^{[1
,13
]}

机构：

[1] McMaster Univ, McMaster Ctr Transfus Res, Dept Med, Hamilton, ON, Canada

[2] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[4] Canadian Blood Serv, Hamilton, ON, Canada

[5] Western Univ, London Hlth Sci Ctr, Schulich Sch Med & Dent, Div Hematol,Dept Med, London, England

[6] Univ Toronto, Li Ka Shing Knowledge Inst, St Michaels Hosp, Dept Med, Toronto, ON, Canada

[7] Univ Toronto, Li Ka Shing Knowledge Inst, St Michaels Hosp, Dept Lab Med, Toronto, ON, Canada

[8] Univ Toronto, Li Ka Shing Knowledge Inst, St Michaels Hosp, Dept Pathobiol, Toronto, ON, Canada

[9] Univ Manitoba, Dept Internal Med, Winnipeg, MB, Canada

[10] CancerCare Manitoba, Dept Med Oncol & Hematol, Winnipeg, MB, Canada

[11] Dalhousie Univ, Dept Med, Div Hematol, Halifax, NS, Canada

[12] Univ Alberta, Dept Med, Div Hematol, Edmonton, AB, Canada

[13] McMaster Univ, Michael G DeGroote Sch Med, Dept Med, Hamilton, ON, Canada

[14] Univ Windsor, Dept Biomed Sci, Windsor, ON, Canada

[15] Western Univ, Schulich Sch Med & Dent, Dept Med, Div Oncol, Windsor Campus, Windsor, ON, Canada

来源：

JOURNAL OF THROMBOSIS AND HAEMOSTASIS | 2022年 / 20卷 / 12期

基金：

加拿大健康研究院;

关键词：

clinical prediction rule; immune thrombocytopenia; platelet count; registry; thrombocytopenia; INTRAVENOUS IMMUNOGLOBULIN; IMPLICIT BIAS; EFFICACY; PURPURA; SAFETY; ADULTS; FORMULATION; 10-PERCENT; SIMULATION; PHYSICIANS;

D O I：

10.1111/jth.15885

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Immune thrombocytopenia (ITP) is a diagnosis of exclusion that can resemble other thrombocytopenic disorders. Objectives To develop a clinical prediction model (CPM) for the diagnosis of ITP to aid hematogists in investigating patients presenting with undifferentiated thrombocytopenia. Methods We designed a CPM for ITP diagnosis at the time of the initial hematology consultation using penalized logistic regression based on data from patients with thrombocytopenia enrolled in the McMaster ITP registry (n = 523) called the Predict-ITP Tool. The case definition for ITP was a platelet count less than 100 x 10(9)/L and a platelet count response after high-dose corticosteroids or intravenous immune globulin, defined as the achievement of a platelet count above 50 x 10(9)/L and at least a doubling of baseline. Internal validation was done using bootstrap resampling. Model discrimination was assessed by the c-statistic, and calibration was assessed by the calibration slope, calibration-in-the-large, and calibration plot. Results The final model included the following variables: (1) platelet count variability (based on three or more platelet count values), (2) lowest platelet count value, (3) maximum mean platelet volume, and (4) history of major bleeding (defined by the ITP bleeding scale). The optimism-corrected c-statistic was 0.83, the calibration slope was 0.88, and calibration-in-the-large for all performance measures was <0.001 with standard error <0.001, indicating good discrimination and excellent calibration. Conclusions The Predict-ITP Tool can estimate the likelihood of ITP for a given patient with thrombocytopenia at the time of the initial hematology consultation. The tool had high predictive accuracy for the diagnosis of ITP.

引用

页码：2988 / 2997

页数：10

共 54 条

[1] Discrimination and Calibration of Clinical Prediction Models Users' Guides to the Medical Literature [J].