Intensive Care Medicine

, Volume 31, Issue 1, pp 71–78

Outcome of severe adult thrombotic microangiopathies in the intensive care unit

Authors

    • Medical Intensive Care Unit Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg Saint-Jacques, 75679 Paris, Franceand Université Paris V
  • Cécile Vigneau
    • Nephrology Department, Tenon HospitalAssistance Publique-Hôpitaux de Paris
  • Marc Auburtin
    • Medical ICU Department, Bichat HospitalAssistance Publique-Hôpitaux de Paris
  • Delphine Moreau
    • Medical ICU Department, Saint-Louis HospitalAssistance Publique-Hôpitaux de Paris
  • Jean-Ralph Zahar
    • Medical ICU Department, Henri Mondor HospitalAssistance Publique-Hôpitaux de Paris
  • Joël Coste
    • Department of Biostatistics, Cochin HospitalAssistance Publique-Hôpitaux de Paris
  • Farhad Heshmati
    • Hemapheresis Department, Cochin HospitalAssistance Publique-Hôpitaux de Paris
  • Jean-Paul Mira
    • Medical ICU Department and Cochin Institute INSERM U567, Cochin HospitalAssistance Publique-Hôpitaux de Paris and Université Paris V
Original

DOI: 10.1007/s00134-004-2505-0

Cite this article as:
Pene, F., Vigneau, C., Auburtin, M. et al. Intensive Care Med (2005) 31: 71. doi:10.1007/s00134-004-2505-0

Abstract

Objective

Thrombotic microangiopathies, namely thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, are uncommon microvascular occlusive diseases. Despite the dramatic improvement in the outcome by exogenous plasma supply, either through plasma infusion or through plasma exchange, patients frequently require support in the intensive care unit. In the present study, we evaluated the outcome of a large cohort of patients with severe thrombotic microangiopathies.

Design

A retrospective multicenter study from January 1998 to June 2001.

Setting

Fourteen French university hospital medical intensive care units.

Patients

Sixty three adult patients with severe thrombotic microangiopathies.

Measurements and results

Of the 63 patients, 19 had a clinical presentation of thrombotic thrombocytopenic purpura, 18 had hemolytic uremic syndrome and 26 had combined neurologic and renal failures. Infections were the main etiology associated with thrombotic microangiopathies. The mortality rate was 35%. Of the survivors, all achieved complete remission. Whereas neurologic failure assessed through the Glasgow coma scale was an independent predictor of mortality [HR=0.845 (CI 95%: 0.759–0.940), P=0.002], renal impairment did not appear to be an adverse prognostic factor. The use of plasma exchange was independently associated with survival [HR=0.269 (CI 95%: 0.104–0.691), P=0.006].

Conclusions

Thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with high mortality. Neurologic impairment appears to be the main adverse prognostic factor correlated to mortality, and the study confirms the importance of plasma exchange in the treatment of high-risk patients.

Keywords

Thrombotic thrombocytopenic purpuraHemolytic uremic syndromeThrombocytopeniaPlasma exchangeFresh frozen plasmaIntensive care unit

Copyright information

© Springer-Verlag 2004