Proteinuria Increases the PLASMIC and French Scores Performance to Predict Thrombotic Thrombocytopenic Purpura in Patients With Thrombotic Microangiopathy Syndrome

Performance of the PLASMIC score is improved with a positive score defined as ≥5 and with the inclusion of neurological symptoms

“…[1][2][3][4]6 To our knowledge this is the first publication to describe the use of these particular modifications, although other modifications to the PLASMIC score have been described in the literature. 3,7,8 We created Mod 3 due to the non-specific nature of some features included in the PLASMIC score. In the patient group with an ADAMTS13 activity of more than 10% in this study, three of the seven features (no active cancer, no transplant history, and INR < 1.5) were each present in 79%-83% of patients.…”

Predictive Scores for Early Identification of Immune-Mediated Thrombotic Thrombocytopenic Purpura: Room for Improvement?

“…Predictive scores for early identification of immune-mediated thrombotic thrombocytopenic purpura: room for improvement? Adrien Joseph 1,2 , Benoit Brilland 2,3 , Laure Burguet 2,4 , Martin Eloit 2,5 , Nicolas Fage 2,3 , Jean-François Augusto 2,3 , Yahsou Delmas 2,4 , Agnès Veyradier 2,6 , Jean-Michel Halimi 2,7 , Paul Coppo Diagnostic performances of these scores are concordant. However, patients with an intermediate score (French score 1 or PLASMIC score 5) still represent a diagnostic issue, as their probability of iTTP remains undetermined.…”

“…First, 2 studies reported that proteinuria improved diagnostic performances of both French and PLASMIC scores. 3 , 4 By pooling patients from these studies ( N = 123) (excluding pregnancy-related TMA), we report that patients with a French score of 1 had a 20% positive predictive value for iTTP diagnosis, which increased to 41% when proteinuria was <1.2 g/g and decreased to 4% if this ratio was ≥1.2 g/g, ( P = 0.011, χ 2 test) ( Table 1 ). In another study, the analysis of blood pressure (BP) for patients with TMA ( n = 539) showed that BP at admission was lower in patients with iTTP.…”

“…Recently, two additional factors were suggested to improve scores' performances. First, two studies reported that proteinuria improved diagnostic performances of both French and PLASMIC scores (3,4). By pooling patients from these studies (n= 123) (excluding pregnancy-related TMA), we report that patients with a French score of 1 had a 20% positive predictive value for iTTP diagnosis, which increased to 41 % when proteinuria was <1.2 g/g and decreased to 4 % if this ratio was ≥1.2 g/g, (p= 0.011, χ2 test) (Table 1).…”

“… 5 ( n = 539 TMAs) Fage et al. 3 and Burguet et al. 4 ( n = 123 TMAs) French score French score 0 1 2 0 1 2 Proportion of iTTP (Severe ADAMTS13 deficiency-proven iTTP/total TMAs by score) 15/139 11% 60/107 56% 282/293 96% 2/38 5% 8/41 20% 35/44 80% Systolic blood pressure Proteinuria > 150 mm Hg ≤ 150 mm Hg ≥ 1.2 g/g < 1.2 g/g 10/28 36% 50/79 63% 1/24 4% 7/17 41% Sensibility 83% 88% Specificity 38% 70% Positive likelihood ratio 1.35 2.89 Negative likelihood ratio 0.44 0.18 iTTP, immune-mediated thrombotic thrombocytopenic purpura; TMAs, thrombotic microangiopathies.…”