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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, METHODS, RESULTS. Meshes: .
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Does bmi strongly impact the diagnosis and incidence of hit in the Sicu? Context: The obese state has been linked to various immune-mediated conditions. Our objective was to examine the association of body mass index (BMI) with the diagnosis of heparin-induced thrombocytopenia (HIT). Prospectively collected data on patients in the surgical and cardiac ICU suspected of having HIT between January 2007 and August 2014 were analyzed. Patients were categorized into 5 discreet BMI (kg/m) groups and compared. Data collected included Warkentin 4-T scores, anti-platelet factor 4 (anti-PF4OD), Serotonin Release Assay (SRA), and thromboembolic diseases. HIT positivity was defined as SRA>20%. Of 304 patients meeting inclusion criteria, mean age was 62.1 ± 16.5 years, 59% were male, and mean BMI was 27 ± 6 kg/m. Thirty-six (12%) were positive for HIT. Incidence of HIT increased progressively with BMI [0%, 8%, 11%, 19%, 36%; p < 0.001]. Compared to patients with normal BMI, patients with BMI 30-39.9 had a 200% increase in the odds for HIT [OR = 2.94, 95% CI = 1.20-7.54, p = 0.019], while patients with BMI ≥40 had a 600% increase [OR = 6.98, 95% CI = 1.59-28.2, p = 0.012]. After regression analysis, BMI remained an independent predictor of the development of HIT (AOR per kg/m [95% CI], 1.08 [1.02 1.14]; p=0.010). Anti-PF4OD ≥2.0 also increased with BMI (p<0.001). In-hospital mortality increased significantly with BMI above normal (p = 0.026). Warkentin 4-T scores, DVT, PE, and stroke incidence did not correlate with changes in BMI.
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Increasing BMI appears to be strongly associated with increased rates of HIT in ICU patients. Obesity is an important new clinical variable for estimating the pre-test probability of HIT, and patient "Thickness" could be considered a 5th "T" of the 4-T scoring. Additional biochemical work is indicated to decipher the role of obesity in this immune-mediated condition. Final Decision: yes