Predictors of mortality in thrombotic thrombocytopenia after adenoviral COVID-19 vaccination: the FAPIC score

Hwang, Jimin and Park, Seung Hyun and Lee, Seung Won and Lee, Se Bee and Lee, Min Ho and Jeong, Gwang Hun and Kim, Min Seo and Kim, Jong Yeob and Koyanagi, Ai and Jacob, Louis and Jeong, Se Yong and Song, Jae Woo and Yon, Dong Keon and Shin, Jae Il and Smith, Lee (2021) Predictors of mortality in thrombotic thrombocytopenia after adenoviral COVID-19 vaccination: the FAPIC score. European Heart Journal, 42 (39). pp. 4053-4063. ISSN 1522-9645

[img] Text
Accepted Version
Restricted to Repository staff only until 21 September 2022.
Available under the following license: Creative Commons Attribution Non-commercial No Derivatives.

Download (906kB) | Request a copy
[img] Text (Word version)
Accepted Version
Restricted to Repository staff only until 21 September 2022.
Available under the following license: Creative Commons Attribution Non-commercial No Derivatives.

Download (2MB) | Request a copy
Official URL: https://doi.org/10.1093/eurheartj/ehab592

Abstract

Aims- 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. Methods and Results- 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. Conclusions- 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.

Item Type: Journal Article
Keywords: vaccine-induced thrombotic thrombocytopenia, ChAdOx1 nCoV-19, COVID-19 vaccine, cerebral venous thrombosis
Faculty: COVID-19 Research Collection
Faculty of Science & Engineering
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 17 Aug 2021 10:40
Last Modified: 21 Jan 2022 15:48
URI: https://arro.anglia.ac.uk/id/eprint/706835

Actions (login required)

Edit Item Edit Item