{"title":"在重症监护室接受治疗的血栓性血小板减少性紫癜患者的疗效。","authors":"Shiva Kumar Narayan, Kiran Kumar Gudivada, Sumitra Sivakoti, Bhuvana Krishna","doi":"10.25259/NMJI_205_21","DOIUrl":null,"url":null,"abstract":"<p><p>Background Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterized by widespread microthrombosis that can predispose to multiple organ failure. The literature is sparse on the outcomes of critically ill patients with TTP managed in intensive care units (ICUs). We aimed to determine the mortality of ICU patients admitted with TTP and evaluate the predictors of survival. We also compared the incidence of nosocomial infection among those who did or did not receive plasma exchange (PE). Methods We conducted a retrospective study in a tertiary ICU. Two authors screened patients for eligibility from the hospital information system based on peripheral smear reports. Adult critically ill TTP patients managed in ICU were included. Patients with a diagnosis of haemolytic uraemic syndrome, autoimmune causes of haemolysis and pregnancy-related conditions, etc. were excluded. Two authors extracted data from medical charts. No imputation of missing variables was done. Non-parametric statistics were used to report data. Statistical analyses were performed using Stata version 16. Results Of the 535 records that were screened, 33 patients were deemed eligible. Mortality among TTP patients was 14 (42%). The women to men ratio was 7:3. At admission, greater degree of anaemia, thrombocytopenia, and higher lactate dehydrogenase levels were observed in non-survivors compared to survivors (5.4 g/dl [4.8-7.1] v. 7.6 g/dl [6.1-8.9], p=0.05; 17x103 μl v. 21x103 μl, p=0.63; and 2987 (1904-3614) U/L v. 2126 U/L (1941-3319), p=0.71; respectively]. Nineteen (57%) patients had acute kidney injury (AKI), of which 11 survived: 6 recovered completely from renal failure and 5 progressed to end-stage renal disease. Nosocomial infection rates were not different among those receiving and not receiving PE therapy (7 [33%] v. 3 [25%], respectively). Conclusion TTP is more common in women and has a high mortality. Older age, low haemoglobin and higher platelet transfusions are predictors of poor survival. Nosocomial infection rates were similar irrespective of receiving PE therapy.</p>","PeriodicalId":519891,"journal":{"name":"The National medical journal of India","volume":"36 5","pages":"295-300"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes of patients with thrombotic thrombocytopenic purpura treated in an intensive care unit.\",\"authors\":\"Shiva Kumar Narayan, Kiran Kumar Gudivada, Sumitra Sivakoti, Bhuvana Krishna\",\"doi\":\"10.25259/NMJI_205_21\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Background Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterized by widespread microthrombosis that can predispose to multiple organ failure. The literature is sparse on the outcomes of critically ill patients with TTP managed in intensive care units (ICUs). We aimed to determine the mortality of ICU patients admitted with TTP and evaluate the predictors of survival. We also compared the incidence of nosocomial infection among those who did or did not receive plasma exchange (PE). Methods We conducted a retrospective study in a tertiary ICU. Two authors screened patients for eligibility from the hospital information system based on peripheral smear reports. Adult critically ill TTP patients managed in ICU were included. Patients with a diagnosis of haemolytic uraemic syndrome, autoimmune causes of haemolysis and pregnancy-related conditions, etc. were excluded. Two authors extracted data from medical charts. No imputation of missing variables was done. Non-parametric statistics were used to report data. Statistical analyses were performed using Stata version 16. Results Of the 535 records that were screened, 33 patients were deemed eligible. Mortality among TTP patients was 14 (42%). The women to men ratio was 7:3. At admission, greater degree of anaemia, thrombocytopenia, and higher lactate dehydrogenase levels were observed in non-survivors compared to survivors (5.4 g/dl [4.8-7.1] v. 7.6 g/dl [6.1-8.9], p=0.05; 17x103 μl v. 21x103 μl, p=0.63; and 2987 (1904-3614) U/L v. 2126 U/L (1941-3319), p=0.71; respectively]. Nineteen (57%) patients had acute kidney injury (AKI), of which 11 survived: 6 recovered completely from renal failure and 5 progressed to end-stage renal disease. Nosocomial infection rates were not different among those receiving and not receiving PE therapy (7 [33%] v. 3 [25%], respectively). Conclusion TTP is more common in women and has a high mortality. Older age, low haemoglobin and higher platelet transfusions are predictors of poor survival. Nosocomial infection rates were similar irrespective of receiving PE therapy.</p>\",\"PeriodicalId\":519891,\"journal\":{\"name\":\"The National medical journal of India\",\"volume\":\"36 5\",\"pages\":\"295-300\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The National medical journal of India\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.25259/NMJI_205_21\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The National medical journal of India","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25259/NMJI_205_21","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景 血栓性血小板减少性紫癜(TTP)是一种多系统疾病,其特点是广泛的微血栓形成,可导致多器官功能衰竭。关于在重症监护病房(ICU)接受治疗的 TTP 重症患者的预后的文献很少。我们旨在确定重症监护病房 TTP 患者的死亡率,并评估生存率的预测因素。我们还比较了接受或未接受血浆置换(PE)的患者的院内感染发生率。方法 我们在一家三级重症监护病房开展了一项回顾性研究。两位作者根据外周涂片报告从医院信息系统中筛选出符合条件的患者。研究纳入了在重症监护室接受治疗的成年 TTP 重症患者。排除了诊断为溶血性尿毒症综合征、自身免疫性溶血和妊娠相关疾病等患者。两位作者从病历中提取了数据。未对缺失变量进行估算。报告数据时使用了非参数统计。统计分析使用 Stata 16 版本进行。结果 在筛选出的 535 份病历中,有 33 名患者被认为符合条件。TTP患者的死亡率为14例(42%)。男女比例为 7:3。入院时,与幸存者相比,非幸存者的贫血程度更严重,血小板减少,乳酸脱氢酶水平更高(5.4 g/dl [4.8-7.1] v. 7.6 g/dl [6.1-8.9],p=0.05;17x103 μl v. 21x103 μl,p=0.63;2987 (1904-3614) U/L v. 2126 U/L (1941-3319),p=0.71;]。19例(57%)患者出现急性肾损伤(AKI),其中11例存活:6 人从肾衰竭中完全康复,5 人发展为终末期肾病。接受和未接受 PE 治疗的患者的院内感染率没有差异(分别为 7 [33%] 对 3 [25%])。结论 TTP 在女性中更为常见,死亡率较高。高龄、低血红蛋白和较多的血小板输注是预示存活率较低的因素。无论接受哪种 PE 治疗,非医院感染率都相似。
Outcomes of patients with thrombotic thrombocytopenic purpura treated in an intensive care unit.
Background Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterized by widespread microthrombosis that can predispose to multiple organ failure. The literature is sparse on the outcomes of critically ill patients with TTP managed in intensive care units (ICUs). We aimed to determine the mortality of ICU patients admitted with TTP and evaluate the predictors of survival. We also compared the incidence of nosocomial infection among those who did or did not receive plasma exchange (PE). Methods We conducted a retrospective study in a tertiary ICU. Two authors screened patients for eligibility from the hospital information system based on peripheral smear reports. Adult critically ill TTP patients managed in ICU were included. Patients with a diagnosis of haemolytic uraemic syndrome, autoimmune causes of haemolysis and pregnancy-related conditions, etc. were excluded. Two authors extracted data from medical charts. No imputation of missing variables was done. Non-parametric statistics were used to report data. Statistical analyses were performed using Stata version 16. Results Of the 535 records that were screened, 33 patients were deemed eligible. Mortality among TTP patients was 14 (42%). The women to men ratio was 7:3. At admission, greater degree of anaemia, thrombocytopenia, and higher lactate dehydrogenase levels were observed in non-survivors compared to survivors (5.4 g/dl [4.8-7.1] v. 7.6 g/dl [6.1-8.9], p=0.05; 17x103 μl v. 21x103 μl, p=0.63; and 2987 (1904-3614) U/L v. 2126 U/L (1941-3319), p=0.71; respectively]. Nineteen (57%) patients had acute kidney injury (AKI), of which 11 survived: 6 recovered completely from renal failure and 5 progressed to end-stage renal disease. Nosocomial infection rates were not different among those receiving and not receiving PE therapy (7 [33%] v. 3 [25%], respectively). Conclusion TTP is more common in women and has a high mortality. Older age, low haemoglobin and higher platelet transfusions are predictors of poor survival. Nosocomial infection rates were similar irrespective of receiving PE therapy.