Retrospective and Systematic Analysis of Causes and Outcomes of Thrombotic Microangiopathies in Routine Clinical Practice: An 11-Year Study

Frontiers in Medicine

article

Nicolas Henry¹  Virginie Besson¹  Jean-François Subra¹  Agnès Duveau¹  Jean-François Augusto¹  Benoit Brilland¹  Chloé Mellaza¹  Nicolas Fage¹  François Beloncle²  Franck Genevieve³  Guillaume Legendre⁴  Corentin Orvain¹  Anne-Sophie Garnier¹  Maud Cousin¹ 

[1] Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers;Service de Médecine Intensive et Réanimation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers;Laboratoire d'Hématologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers;Département de Gynécologie et Obstétrique, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers

关键词: Thrombotic microangiopathies;    etiology;    primary;    secondary;    thrombotic thrombocytopenic purpura;    hemolytic uremic syndrome;    real-life;   

DOI  :  10.3389/fmed.2021.566678

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Thrombotic microangiopathies (TMAs) are highly suspected in patients showing mechanical hemolytic anemia, thrombocytopenia, and haptoglobin consumption. Primary [thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome] and secondary TMA are considered. Even if ADAMTS13 measurements and alternative complement pathway explorations have greatly improved the ability to identify primary TMA, their diagnosis remains difficult, and their frequency relative to that of secondary TMA is undetermined. The objectives of the present study were, therefore, to describe the etiologies, management, and the outcomes of patients presenting with TMA in real-life clinical practice. Methods: We conducted a retrospective study between 01/01/2008 and 31/12/2018 that included all consecutive patients presenting with biological TMA syndrome at admission or developing during hospitalization. Patients were identified from the laboratory databases, and their medical files were reviewed to confirm TMA diagnosis, to determine etiology, and to analyze their therapeutic management and outcomes. Results: During this period, 239 patients with a full TMA biological syndrome were identified, and the TMA diagnosis was finally confirmed in 216 (90.4%) after the cases were reviewed. Primary TMAs (thrombotic thrombocytopenic purpura or atypical hemolytic uremic syndrome) were diagnosed in 20 of 216 patients (9.3%). Typical HUS was diagnosed in eight patients (3.7%), and the most frequent secondary TMAs were HELLP syndrome (79/216, 36.6%) and active malignancies (30/219, 13.9%). ADAMTS13 measurements and alternative complement pathway analyses were performed in a minority of patients. Multiple factors identified as TMA triggers were present in most patients, in 55% of patients with primary TMA, vs. 44.7% of patients with secondary TMA ( p = 0.377). Death occurred in 57 patients (23.4%) during follow-up, and dialysis was required in 51 patients (23.6%). Active malignancies [odds ratio (OR) 13.7], transplantation (OR 4.43), male sex (OR 2.89), and older age (OR 1.07) were significantly associated with death. Conclusion: Secondary TMAs represent many TMA causes in patients presenting a full TMA biological syndrome during routine clinical practice. Multiple factors favoring TMA are present in about half of primary or secondary TMA. ADAMTS13 and complement pathway were poorly explored in our cohort. The risk of death is particularly high in patients with malignancies as compared with patients with other TMA.

【 授权许可】

CC BY