Intensive Care Medicine

, Volume 38, Issue 11, pp 1810–1817

Causes and risk factors of death in patients with thrombotic microangiopathies

  • Vincent Peigne
  • Pierre Perez
  • Matthieu Resche Rigon
  • Eric Mariotte
  • Emmanuel Canet
  • Jean-Paul Mira
  • Paul Coppo
  • Agnès Veyradier
  • Elie Azoulay
Original

DOI: 10.1007/s00134-012-2638-5

Cite this article as:
Peigne, V., Perez, P., Resche Rigon, M. et al. Intensive Care Med (2012) 38: 1810. doi:10.1007/s00134-012-2638-5

Abstract

Purpose

Although plasma therapy of thrombotic micro-angiopathies (TMAs) has dramatically improved survival, the outcome remains fatal in up to 15 % of patients. We investigated the causes and risk factors of death in patients with TMA.

Methods

Retrospective matched case–control national-registry study of 57 patients who died within 180 days of TMA diagnosis and 48 survivors matched on age, gender, and baseline platelet count and creatinine level. The study period was 1995–2007. Factors associated with mortality were identified using a conditional logistic regression model.

Results

Median time from TMA symptom onset to death was 7 (5–14) days. The leading causes of death were nosocomial infections, myocardial infarction, stroke, and pulmonary embolism. Cases and controls did not differ significantly regarding haemolysis parameters, ADAMTS13 activity, or neurological or gastrointestinal involvement. TMA was more frequently related to HIV or cancer in patients who died. Compared to survivors, non-survivors more often had cardiac involvement at diagnosis (38 vs. 6 %, p = 0.03) and less often received plasma exchange therapy (60 vs. 92 %, p = 0.004). Only two factors were independently associated with mortality by multivariate analysis: cardiac involvement at diagnosis (odds ratio, 5.96; 95 % confidence interval, 1.06–33.4) and plasma exchange therapy (odds ratio, 0.25; 95 % confidence interval, 0.06–0.99).

Conclusion

Our data emphasise the adverse prognostic significance of cardiac abnormalities and support routine plasma exchange in patients with TMA. Given the high risk of cardiac and neurological complications, adequate monitoring should be proposed to these patients in appropriate hospital settings.

Keywords

Haemostasis disordersTransfusion

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Vincent Peigne
    • 1
  • Pierre Perez
    • 1
  • Matthieu Resche Rigon
    • 1
  • Eric Mariotte
    • 1
  • Emmanuel Canet
    • 1
  • Jean-Paul Mira
    • 1
  • Paul Coppo
    • 1
  • Agnès Veyradier
    • 1
  • Elie Azoulay
    • 1
  1. 1.AP-HP, Hôpital Saint-Louis Medical ICUParisFrance