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. 2023 Mar 31;58(1):36-41.
doi: 10.5045/br.2023.2022133. Epub 2023 Jan 12.

Validating lactate dehydrogenase (LDH) as a component of the PLASMIC predictive tool (PLASMIC-LDH)

Christopher Chin Keong Liam  1   2   3 , Jim Yu-Hsiang Tiao  1   2 , Yee Yee Yap  3 , Yi Lin Lee  4 , Jameela Sathar  3 , Simon McRae  5 , Amanda Davis  6 , Jennifer Curnow  7 , Robert Bird  8 , Philip Choi  9 , Pantep Angchaisuksiri  10 , Sim Leng Tien  11 , Joyce Ching Mei Lam  12 , Doyeun Oh  13 , Jin Seok Kim  14 , Sung-Soo Yoon  15 , Raymond Siu-Ming Wong  16 , Carolyn Lauren  17 , Eileen Grace Merriman  18   19 , Anoop Enjeti  20 , Mark Smith  17 , Ross Ian Baker  1   2
Affiliations

Validating lactate dehydrogenase (LDH) as a component of the PLASMIC predictive tool (PLASMIC-LDH)

Christopher Chin Keong Liam et al. Blood Res. .

Abstract

Background: The PLASMIC score is a convenient tool for predicting ADAMTS13 activity of <10%. Lactate dehydrogenase (LDH) is widely used as a marker of haemolysis in thrombotic thrombocytopenic purpura (TTP) monitoring, and could be used as a replacement marker for lysis. We aimed to validate the PLASMIC score in a multi-centre Asia Pacific region, and to explore whether LDH could be used as a replacement marker for lysis.

Methods: Records of patients with thrombotic microangiopathy (TMA) were reviewed. Patients' ADAMTS13 activity levels were obtained, along with clinical/laboratory findings relevant to the PLASMIC score. Both PLASMIC scores and PLASMIC-LDH scores, in which LDH replaced traditional lysis markers, were calculated. We generated a receiver operator characteristics (ROC) curve and compared the area under the curve values (AUC) to determine the predictive ability of each score.

Results: 46 patients fulfilled the inclusion criteria, of which 34 had ADAMTS13 activity levels of <10%. When the patients were divided into intermediate-to-high risk (scores 5‒7) and low risk (scores 0‒4), the PLASMIC score showed a sensitivity of 97.1% and specificity of 58.3%, with a positive predictive value (PPV) of 86.8% and negative predictive value (NPV) of 87.5%. The PLASMIC-LDH score had a sensitivity of 97.1% and specificity of 33.3%, with a PPV of 80.5% and NPV of 80.0%.

Conclusion: Our study validated the utility of the PLASMIC score, and demonstrated PLASMIC-LDH as a reasonable alternative in the absence of traditional lysis markers, to help identify high-risk patients for treatment via plasma exchange.

Keywords: Lactate dehydrogenase (LDH); PLASMIC score; Thrombotic microangiopathy.

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Conflict of interest statement

Authors’ Disclosures of Potential Conflicts of Interest

No potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
Study cohort design outlining the method of patient selection for analysis. The total PLASMIC/ PLASMIC LDH score was calculated with one point designated for each component and subsequently stratified into low risk (0–4 points), intermediate risk (5 points), and high risk (6–7 points).
Fig. 2
Fig. 2
DeLong’s test for the receiver operator curve (ROC) with a comparison of the area under the curve (AUC) of PLASMIC (black) and PLASMIC-LDH (blue).
See this image and copyright information in PMC

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