Abstract
Aim of the study was the definition of a predictive model for the initial diagnosis of thrombotic microangiopathies (TMA). We retrospectively collected data on all adult patients admitted to the Gemelli Hospital from 2010 to 2014. ICD-9 codes from primary diagnoses were used for TMA diagnosis. Demographic and laboratory characteristics on admission of patients with TMA were then compared with a random sample of 500 patients with other diagnoses. The prediction model was externally validated in a cohort from another hospital. Overall, 23 of 187,183 patients admitted during the study period received a primary diagnosis of TMA. LDH (OR 1.26, 95% CI 1.05, 1.63) and platelets (OR 0.96, 95% CI 0.94, 0.98) were the only independent predictors of TMA. The AUROC of the final model including only LDH and platelets was 0.96 (95% CI 0.91, 1.00). The Hosmer–Lemeshow (HL) test (p = 0.54) suggested good calibration. Our model also confirmed good discriminatory power (AUROC 0.72 95% CI 0.60, 0.84) and calibration (HL test p = 0.52) in the validation sample. We present a simple prediction model for use in diagnosing TMA in hospitalized patients. The model performs well and can help clinicians to identify patients at high risk of TMA.
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Acknowledgements
Gambaro and Ferraro designed the research; Gambaro, Ferraro, Lombardi, De Stefano, Zuppi, Bonelli, Buonocore, Cervellin and Lippi acquired the data; Ferraro and Lombardi performed the statistical analyses; Gambaro, Ferraro, Lombardi, De Stefano and Lippi drafted the paper; Zuppi, Bonelli, Buonocore, Cervellin, Naticchia and Sturniolo critically revised the paper; all the authors approved the final version of the manuscript.
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The study protocol was approved by the IRB of the Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Rome.
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Ferraro, P.M., Lombardi, G., Naticchia, A. et al. A STARD-compliant prediction model for diagnosing thrombotic microangiopathies. J Nephrol 31, 405–410 (2018). https://doi.org/10.1007/s40620-018-0468-4
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DOI: https://doi.org/10.1007/s40620-018-0468-4