Researchers aimed to identify predictors of mortality in hospitalized pediatric patients with thrombotic thrombocytopenic purpura (TTP). Their findings were published in the Journal of Pediatric Hematology/Oncology.
In this analysis of patients with TTP, the researchers evaluated data from 2 sources, the Kids’ Inpatient Database (KID) and National Inpatient Sample (NIS), to detect risk factors for in-hospital mortality in patients who received therapeutic plasmapheresis during TTP-related hospitalizations in the United States from 2003 through 2016. The KID is restricted to patients below 20 years of age, while the NIS is not age restricted, and the researchers used the NIS during years when KID data were unavailable.
The researchers identified 69 deaths associated with 1568 TTP-related hospitalizations, yielding a 0.04% rate of all-cause mortality during these hospitalizations, with a median time-to-death of 6 weeks.
More than half of the deaths in this study occurred in patients who were 16 to 20 years of age (58%) or female (56.5%). However, multivariate logistic regression analysis revealed both younger age and male sex to be independent predictors of in-hospital mortality, in addition to several other demographic and clinical factors. These included African American ethnicity and other nonwhite, non-Hispanic demographic characteristics.
Clinical characteristics that appeared to be independent risk factors for in-hospital mortality included presence of a malignancy, sepsis, acute kidney injury, and treatment with platelet transfusions during the hospitalization. In-hospital mortality was significantly less common among patients who received red blood cell transfusions while hospitalized.
The researchers indicated that vigilance is warranted when treating patients with TTP who have risk factors for in-hospital mortality, even when therapeutic plasmapheresis is given. “Early therapeutic intervention is needed in patients with high risk of mortality in TTP,” they concluded.
1. Umapathi KK, Thavamani A, Puliyel M. Predictors of in-hospital mortality in thrombotic thrombocytopenic purpura in children in the United States: a population analysis [published online January 31, 2020]. J Pediatr Hematol Oncol. doi: 10.1097/MPH.0000000000001725