Cardiovascular Complications and Their Association With Mortality in Patients With Thrombotic Thrombocytopenic Purpura

Balasubramaniyam, Nivas; Yandrapalli, Srikanth; Kolte, Dhaval; Pemmasani, Gayatri; Janakiram, Murali; Frishman, William H.

doi:10.1016/j.amjmed.2020.06.020

Cited by 14 publications

(7 citation statements)

References 20 publications

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“…TTP is associated with infections, diabetes, hypertension, obesity, metabolic syndrome, and cardiovascular disease [6]; the incidence of cardiovascular complications in patients hospitalized for TTP is approximately 25% and is associated with higher mortality [16]. However, other reports have indicated that there was no difference between the survivors and non-survivors with diabetes, hypertension, and obesity [14].…”

Section: Discussionmentioning

confidence: 99%

Stress-induced hyperglycemia is associated with the mortality of thrombotic thrombocytopenic purpura patients

Hu,

Wang,

Jin

et al. 2024

Diabetol Metab Syndr

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Background Thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy with a rapid progression and high mortality rate. We aimed to explore early risk factors for mortality in patients with TTP. Methods We conducted a retrospective analysis of 42 TTP patients that were admitted to our hospital between 2000 and 2021, with a median age of 49 (29–63) years. Risk factors for mortality were evaluated using multivariate logistic regression. Receiver operating characteristic curve analysis was used to determine the cut-off value of glucose for predicting mortality in patients, which was validated by comparison to a similar cohort in the published literature. Results Elevated glucose level and reduced red blood cells (RBC) counts were risk factors for mortality in patients with TTP (glucose, odds ratio and 95% confidence interval: 2.476 [1.368–4.484]; RBC, odds ratio and 95% confidence interval: 0.095 [0.011–0.799]). The area under the curve of glucose was 0.827, and the cut-off value was 9.2 mmol/L, with a sensitivity of 75.0% and specificity of 95.8%. A total of 26 cases from the validation cohort had a sensitivity of 71.0% and a specificity of 84.0%. The change trends of the TTP-related laboratory indices differed during hospitalization. Conclusion Hyperglycemia at admission and unstable blood glucose levels during hospitalization may be potential predictors of mortality for TTP patients. The improved prognosis was associated with the recovery of platelet counts and a significant decrease in serum lactate dehydrogenase after five days of treatment.

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Section: Discussionmentioning

confidence: 99%

Stress-induced hyperglycemia is associated with the mortality of thrombotic thrombocytopenic purpura patients

Hu,

Wang,

Jin

et al. 2024

Diabetol Metab Syndr

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“…Overall acute MI rates of approximately 5–15% have been reported in acute iTTP, and non-ST segment elevation MI is more common than ST segment elevation MI [ 20 , 21 ]. While a smaller study did not find an association of traditional risk factors with MI in iTTP, a larger analysis from the United States Nationwide Inpatient Sample suggests that older age, smoking, known coronary artery disease, and congestive heart failure are associated with increased risk of MI with acute iTTP, and overt cardiovascular complications are associated with substantially higher in-hospital mortality [ 21 , 22 ]. Even patients without overt symptoms may have cardiac involvement of iTTP evidenced by troponin elevation and electrocardiogram changes [ 23 ].…”

Section: Cardiovascular Involvement In Acute Ittpmentioning

confidence: 99%

Cardiovascular Disease and Stroke in Immune TTP–Challenges and Opportunities

Sukumar,

Mazepa,

Chaturvedi

2023

JCM

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Advances in the management of immune thrombotic thrombocytopenic purpura (iTTP) have dramatically improved outcomes of acute TTP episodes, and TTP is now treated as a chronic, relapsing disorder. It is now recognized that iTTP survivors are at high risk for vascular disease, with stroke and myocardial infarction occurring at younger ages than in the general population, and cardiovascular disease is the leading cause of premature death in this population. iTTP appears to have a phenotype of accelerated vascular aging with a particular predilection for cerebral circulation, and stroke is much more common than myocardial infarction. In addition to traditional cardiovascular risk factors, low ADAMTS13 activity during clinical remission may be a risk factor for some of these outcomes, such as stroke. Recent studies also suggest that Black patients, who are disproportionately affected by iTTP in the United States, are at higher risk of adverse cardiovascular outcomes, likely due to multifactorial reasons. Additional research is required to establish the risk factors and mechanisms underlying these complications in order to institute optimal screening strategies and identify interventions to improve outcomes.

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“…У переживших приступ ТТП пациентов была в 2 раза больше частота смерти от сердечно-сосудистых осложнений, чем в общей популяции [96]. При анализе 15 504 госпитализаций больных ТТП описаны такие сердечно-сосудистые осложнения, как сердечная недостаточность (8,3%), острый коронарный синдром (6,4%), суправентрикулярная тахиаритмия (5,9%), желудочковая тахиаритмия (2%), кардиогенный шок (0,5%), кардиомиопатия (0,1%), атриовентрикулярная блокада (0,2%) миокардит и/или перикардит (0,3%), сердечный арест (1,9%) [97]. Частота сердечно-сосудистых осложнений возрастает у больных старше 55 лет [97].…”

Section: прогнозunclassified

Treatment of thrombotic thrombocytopenic purpura

Galstyan¹,

Maschan

Klebanova³

et al. 2021

Terapevticheskii arkhiv

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The review discusses approaches to treatment of acquired thrombotic thrombocytopenic purpuгa (aTTP). In patients with aTTP plasma exchanges, glucocorticosteroids allow to stop an acute attack of TTP, and use of rituximab allows to achieve remission. In recent years, caplacizumab has been used. Treatment options such as cyclosporin A, bortezomib, splenectomy, N-acetylcysteine, recombinant ADAMTS13 are also described. Separately discussed issues of management of patients with TTP during pregnancy, and pediatric patients with TTP.

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Cardiovascular Complications and Their Association With Mortality in Patients With Thrombotic Thrombocytopenic Purpura

Cited by 14 publications

References 20 publications

Stress-induced hyperglycemia is associated with the mortality of thrombotic thrombocytopenic purpura patients

Stress-induced hyperglycemia is associated with the mortality of thrombotic thrombocytopenic purpura patients

Cardiovascular Disease and Stroke in Immune TTP–Challenges and Opportunities

Treatment of thrombotic thrombocytopenic purpura

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