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Predictors of In-hospital Mortality and Acute Myocardial Infarction in Thrombotic Thrombocytopenic Purpura
发布于：2013年11月11日 文字：【大】【中】【小】
Predictors of In-hospital Mortality and Acute Myocardial Infarction in Thrombotic Thrombocytopenic Purpura
Am J Med. 2013 Nov
BACKGROUND: Despite the widespread availability of plasmapheresis as a therapy, thrombotic thrombocytopenic purpura is associated with significant morbidity and mortality. There is a paucity of data on the predictors of poor clinical outcome in this population. Acute myocardial infarction is a recognized complication of thrombotic thrombocytopenic purpura. Little is known about the magnitude of this problem, its risk factors, and its influence on mortality in patients hospitalized with thrombotic thrombocytopenic purpura.
METHODS: We used the 2001-2010 Nationwide Inpatient Sample database to identify patients aged ≥18 years with the diagnosis of thrombotic thrombocytopenic purpura (International Classification of Diseases, 9(th) Revision, Clinical Modification [ICD-9-CM] code 446.6) who also received therapeutic plasmapheresis (ICD-9-CM code 99.71) during the hospitalization. Patients with acute myocardial infarction were identified using the Healthcare Cost and Utilization Project Clinical Classification Software code 100. Stepwise logistic regression was used to determine independent predictors of in-hospital mortality and acute myocardial infarction in thrombotic thrombocytopenic purpura patients.
RESULTS: We used the 2001-2010 Nationwide Inpatient Sample database to identify patients aged ≥18 years with the diagnosis of thrombotic thrombocytopenic purpura (International Classification of Diseases, 9(th) Revision, Clinical Modification [ICD-9-CM] code 446.6) who also received therapeutic plasmapheresis (ICD-9-CM code 99.71) during the hospitalization. Patients with acute myocardial infarction were identified using the Healthcare Cost and Utilization Project Clinical Classification Software code 100. Stepwise logistic regression was used to determine independent predictors of in-hospital mortality and acute myocardial infarction in thrombotic thrombocytopenic purpura patients).
CONCLUSION: In this large national database, patients with thrombotic thrombocytopenic purpura had an in-hospital mortality rate of 11.1% and an acute myocardial infarction rate of 5.7%. Predictors of in-hospital mortality were older age, acute myocardial infarction, acute renal failure, congestive heart failure, acute cerebrovascular disease, cancer, and sepsis. Predictors of acute myocardial infarction were older age, smoking, known coronary artery disease, and congestive heart failure.
血栓性血小板减少性紫癜（TTP）在血浆置换/血浆输注治疗后死亡率从90%下降至10%，但之后死亡率一直无明显变化。TTP预后不良的相关临床指标的相关研究较少；急性心肌梗死是TTP比较严重的临床表现，其相关研究也比较少。本研究包括了美国4032例年龄>18岁、接受血浆置换的TTP患者，总住院死亡率为11.1%，急性心肌梗死发生率为5.7%；住院死亡率的独立危险因素包括：高龄、急性心肌梗死、急性肾衰竭、充血性心力衰竭、急性脑血管病、肿瘤和败血症；急性心肌梗死的独立危险因素包括：高龄，吸烟，已知的冠脉病变和充血性心力衰竭。
http://www.ncbi.nlm.nih.gov/pubmed/23993262