Abstract Number: PB1878
Meeting: ISTH 2020 Congress
Background: Neurologic complications are present in up to 60% of thrombotic thrombocytopenic purpura (TTP) episodes and contribute to adverse clinical outcomes and death. Although the central nervous system is the leading target organ in TTP, risk factors associated with neurological complications are not established.
Aims: To evaluate parameters associated with severe neurological complications during TTP episodes. We also evaluated the association of these complications with treatment outcomes, such as number of plasma exchange procedures, days in hospital and death.
Methods: We included a cohort of TTP patients treated at the Clinical Hospital of the University of Campinas – Brazil between 1995 and 2016. Clinical parameters at baseline were considered as potential risk factors for severe neurological complications and were evaluated in regression models.
Results: A total of 67 TTP episodes in 51 patients were included. Forty-one (80%) patients were women, and the mean age was 35 years (SD 12). Neurological symptoms occurred in 78% of TTP episodes: headache only (15%); confusion, personality change, sensorimotor loss or seizures (31%) and coma (33%). First TTP episode, lower platelet and higher reticulocyte count and higher PLASMIC score were detected in TTP with severe neurological complications as compared to TTP with no such complications. The parameters associated with the risk of severe neurological complications were first TTP episode (OR 2.45 95%IC 1.39 – 5.59, P=0.01) and the PLASMIC score (OR 2.39 95% IC 1.12 – 5.75, P=0.03). Severe neurological complications were associated with higher in-hospital stay, with a hospitalization period 7 days longer when compared to no neurological complications (mean difference 6.87 95% CI -0.1 – 13.8, P=0.05).
Conclusions: First TTP episode and higher PLASMIC score values are associated with severe neurological complications. PLASMIC score may represent a prognostic tool from a neurological point of view. Awareness of the risk of neurological complications may improve TTP treatment.
N | 67 |
First episode (%) | 50 (74.6) |
PLT count x109 per L (mean (SD)) | 20158.21 (16857.75) |
Reticulocyte % (mean (SD)) | 9.00 (5.59) |
Creatinine mg dL-1 (mean (SD)) | 1.27 (1.52) |
PLASMIC SCORE 6 or 7 (%) | 57 (85.1) |
Neurological = Y (%) | 52 (77.6) |
Ischemic stroke during PTT episode (%) | N: 31 (46.3) Y: 6 (9.0) NA: 30 (44.8) |
Days in hospital (mean (SD)) | 26.45 (13.98) |
Death during hospitalization = Y (%) | 5 (7.5) |
[Table 1: Clinical characteristics of TTP episodes at diagnosis and clinical evolution during hospitalization.]
N (neurological complications) | Y (neurological complications) | P | |
Order of episode (%) 1 2 3 4 5 6 8 9 10 | 12 (50.0) 4 ( 16.7) 1 ( 4.2) 2 ( 8.3) 1 ( 4.2) 1 ( 4.2) 1 ( 4.2) 1 ( 4.2) 1 ( 4.2) | 38 (88.4) 3 (7.0) 1 ( 2.3) 1 ( 2.3) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) | 0.063 |
PLT count x109 per L (mean (SD)) | 26208.33 (22049.31) | 16781.40 (12155.09) | 0.027 |
Reticulocyte % (mean (SD)) | 6.95 (5.05) | 10.11 (5.61) | 0.040 |
Creatinine mg dL-1 (mean (SD)) | 1.72 (2.44) | 1.01 (0.41) | 0.069 |
PLASMIC SCORE (%) 4 5 6 7 | 2 ( 8.3) 6 ( 25.0) 9 ( 37.5) 7 ( 29.2) | 1 ( 2.3) 1 ( 2.3) 23 ( 53.5) 18 ( 41.9) | 0.016 |
Start of simptoms and star of tratament (days) (mean (SD)) | 10.84 (10.44) | 17.70 (13.48) | 058 |
Ischemic stroke during PTT episode (%) N Y NA | 6 ( 25.0) 0 (0.0) 18 ( 75.0) | 25 (58.1) 6 (14.0) 12 ( 27.9) | 0.001 |
Days in hospital (mean (SD)) | 22.04 (11.37) | 28.91 (14.80) | 0.053 |
Death during hospitalization = Y (%) | 1 (4.2) | 4 (9.3) | 0.778 |
[Table 2: Clinical features of TTP episodes by neurological complications.]
To cite this abstract in AMA style:
Castro JTS, Mazetto BDM, Rosa AP, Yamagutti G, Paulo EV, Bizachi JA, Reis F, Orsi FA. Risk Factors Associated with Severe Neurological Symptoms in Thrombotic Thrombocytopenic Purpura (TTP) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/risk-factors-associated-with-severe-neurological-symptoms-in-thrombotic-thrombocytopenic-purpura-ttp/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/risk-factors-associated-with-severe-neurological-symptoms-in-thrombotic-thrombocytopenic-purpura-ttp/