Abstract Number: PB1885
Meeting: ISTH 2020 Congress
Background: The PLASMIC score was recently developed for rapid diagnosis of thrombotic thrombocytopenic purpura (TTP) and therapeutic decision as ADAMTS13 is frequently unavailable. Although the PLASMIC score is validated to predict ADAMTS13 values, its role as a predictor of adverse clinical outcomes is not established.
Aims: The primary aim of this study was to evaluate whether the PLASMIC score is associated with neurological complications during TTP episodes.
Methods: In the present study, we retrospectively applied the PLASMIC score at the time of diagnosis of TTP episodes treated at the UNICAMP Clinical Hospital (Brazil) between 1995 and 2016. We divided the episodes according to the PLASMIC score, and compared the occurrence of neurological symptoms and other clinical manifestation between the PLASMIC score groups. A total of 50 episodes of TTP were identified, of these 47 episodes, and 34 patients, were included in the study.
Results: At the diagnosis, the mean PLASMIC score was 6. In 74.5% of the episodes, the patients presented with some neurological symptoms. The incidence of neurological symptoms was higher in PLASMIC score 7 (n= 14 [87, 5%]) and 6 (18 [81, 8%]) when compared with scores 5 (n=1, [16.7%) and 4 (n= 2 (66.7%]). The severity of the neurological complications was also higher in PLASMIC scores 6 and 7. Stupor or coma were reported only in PLASMIC scores 6 [n=7 (31%]) and 7 (n= 9 [56%]). Splenectomy and deaths during hospitalization occurred only in cases with PLASMIC score 6 or 7.
Conclusions: The frequency and severity of neurological injuries increased with a higher PLASMIC score. This observation suggests that TTP patients with PLASMIC score 6 or 7 need more attention regarding neurological complications. It is possible also that these patients benefit from intensive treatments. Therefore, the PLASMIC score may be an important tool not only to predict ADAMTS13.
| All TTP episodes | PLASMIC score 4 | PLASMIC score 5 | PLASMIC score 6 | PLASMIC score 7 | P value | |
| Age at diagnosis (mean (SD)) | 35.73 (12.71) | 35.38 (9.74) | 37.98 (19.16) | 36.38 (10.73) | 34.08 (13.91) | 0.921 |
| Neurological (eg headache, confusion, personality change, sensorimotor loss, seizures, com = Y % | 35 (74.5%) | 2 ( 66.7%) | 1 ( 16.7%) | 18 (81,8%) | 14 (87,5%) | 0.005 |
| Days in hospital (mean (SD)) | 27.04 (14.38) | 23.67 (18.58) | 16.67 (9.52) | 30.36 (14.00) | 27.00 (14.88) | 0.218 |
| Infection = Y (%) | 25 (53.2%) | 1 (33.3) | 1 (16.7%) | 7 (31.8%) | 9 (56,2%) | 0.042 |
| Fever = Y (%) | 27 (57.4%) | 0 (0.0) | 1 (16.7%) | 14 (63.6%) | 9 (56.2%) | 0.194 |
| Steroids = Y (%) | 43 (91.5%) | 1 (33.3) | 0 (0.0) | 13 (59.1) | 14 (87.5) | 0.060 |
| Vincristine = Y (%) | 23 (48.9%) | 1 (33.3) | 0 (0.0) | 3 (13.6) | 9 (56.2) | 0.063 |
| In hospital splenectomy = Y (%) | 8 (17.0%) | 0 | 0 | 5 ( 22.7%) | 3 ( 18.8%) | 0.496 |
| Death in hospital = Y (%) | 4 (8.5%) | 0 | 0 | 3 (13,6%) | 1 (6,2%) | 0.640 |
[Table 1: Clinical characteristics of TTP episodes at diagnosis and clinical evolution during hospitalization.]
| All TTP episodes | PLASMIC score 4 | PLASMIC score 5 | PLASMIC score 6 | PLASMIC score 7 | P value | |
| Type of neurological complication | ||||||
| Headache only = Y (%) | 23 (48.9%) | 1 (33.3%) | 0 | 2 (9,1%) | 2 (12,5%) | 0.07 |
| Confusion = Y (%) | 18 (38.3%) | 1 (33.3%) | 1 (16.7%) | 11 (50%) | 5 (31,2%) | 0.418 |
| Personality Chance = Y (%) | 6 (12.8%) | 0 | 0 | 2 (9.1%) | 4 (25%) | 0.292 |
| Sensorimotor loss = Y (%) | 22 (46.8%) | 0 | 1 (16.7%) | 11 (50%) | 10 (62.5%) | 0.090 |
| Seizures = Y (%) | 8 (17.0%) | 0 | 0 | 3 (13,6%) | 5 (31,2%) | 0.229 |
| Stuporous or Comatose = Y (%) | 16 (34.0%) | 0 | 0 | 7 ( 31.8%) | 9 (56,2%) | 0.042 |
[Table 2: Type of neurological complication]
To cite this abstract in AMA style:
Castro JTdS, Mazetto BDM, Rosa AP, Yamagutti G, Colella M, Paulo EV, Bizachi JA, Reis F, Orsi FA. Association of Plasmic Score with Neurological Symptoms in Patients with Thrombotic Thrombocytopenic Purpura (TTP) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/association-of-plasmic-score-with-neurological-symptoms-in-patients-with-thrombotic-thrombocytopenic-purpura-ttp/. Accessed September 29, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/association-of-plasmic-score-with-neurological-symptoms-in-patients-with-thrombotic-thrombocytopenic-purpura-ttp/