Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially lethal condition. Prognostic factors have not been well established due to the rarity of the disease. The objective of the study was to establish prognostic factors in our hospital population and to compare it with the pre-existing Rose score.
Retrospective analysis of all patients admitted to our hospital with TTP, from 1987–2008 was conducted. The association between multiple variables and the one-month mortality and relapse was analyzed using univariate and multivariate models.
A total of 56 episodes of TTP were reviewed. The majority of patients were African-Americans (76%), females (75%) with a mean age of 54.2 years (SD ± 1.9). 7(12.5%) patients died and 14(25%) relapsed. All patients received plasma exchange (10.2 sessions (SD ± 6.8) per patient). Fever (P = 0.005), age (P = 0.08; 55.5 ± SE1.9 vs. 45.2 ± SE6.4), time for LDH to recover (P < 0.001; days 10 ± SE1.5 vs. 30 ± SE 0.1) and time for platelets to recover (P = 0.042; days 8.2 ± SE1.0 vs. 22 ± SE 5.1) were associated with increased mortality in the univariate analysis. Using the multivariate analysis, there were no predictors of mortality. The presence of 5 or more points in the modified Rose score was associated with increased mortality (P = 0.09). None of the variables could predict relapse.
In patients with TTP, fever on presentation is a poor prognostic factor. Older age and 5 or more points in the modified Rose score can also predict poor prognosis. During the course of the treatment, a delayed recovery of platelets and LDH might also identify patients that require more intense care. These findings provide additional insight into the predictors of mortality in patients with this rare entity.
Patients of TTP with fever and with delayed recovery of LDH and platelets, should be monitored closely as they could have a worse prognosis.
Shikha Gupta, No Financial Disclosure Information; No Product/Research Disclosure Information