Department of Medicine, NYU Langone Health, New York, New York, USA.
Department of Pathology, Mount Sinai Hospital, New York, New York, USA.
J Clin Apher. 2022 Oct;37(5):507-511. doi: 10.1002/jca.22000. Epub 2022 Aug 18.
Per the American Society for Apheresis, therapeutic plasma exchange (TPE) is a Category III indication in the management of immune thrombocytopenia (ITP). This nationally representative study evaluates TPE utilization in hospitalized adults with a primary admission diagnosis of ITP. Hospitalizations with ITP as the primary admitting diagnosis were analyzed from the 2010 to 2014 National Inpatient Sample, the largest all-payer inpatient database in the United States. Univariate and multivariable logistic regressions were used to determine clinical outcomes in ITP patients undergoing TPE. Sampling weights were applied to generate nationally representative estimates. From 2010 to 2014, there were a total of 56,149 admissions with a primary admitting diagnosis of ITP, of which 0.66% admissions (n = 372) also coded TPE. Most subjects undergoing TPE were the highest disease severity class: major (34.6%) and extreme severity (31.0%), by all-patients refined diagnoses-related groups severity of illness subclass. After multivariable analysis, underlying severity of illness remained the most significant predictor of TPE (P < .001). ITP admissions with TPE had a high rate of comorbidities (50%) and significantly longer mean length of hospital stay than those without (P < .001). TPE was reported in ~0.6% of hospitalizations with ITP as the primary diagnosis in this nationally representative sample from 2010 to 2014. TPE was performed in patients with the highest severity of underlying illness, and higher rates of comorbidities.
根据美国血浆分离协会的规定，治疗性血浆置换（TPE）是免疫性血小板减少症（ITP）治疗的 III 类适应证。这项具有全国代表性的研究评估了 TPE 在因 ITP 初次住院的成年患者中的应用。对 2010 年至 2014 年国家住院患者样本中 ITP 为主要诊断的住院患者进行了分析，该样本是美国最大的所有支付者住院患者数据库。采用单变量和多变量逻辑回归分析确定接受 TPE 的 ITP 患者的临床结局。应用抽样权重生成具有全国代表性的估计值。2010 年至 2014 年，共有 56149 例因 ITP 初次住院的患者，其中 0.66%（n=372）的患者还编码了 TPE。大多数接受 TPE 的患者为疾病严重程度最高的类别：所有患者精细诊断相关组严重程度亚类的主要（34.6%）和极严重（31.0%）。经过多变量分析，基础疾病严重程度仍然是 TPE 的最显著预测因素（P<.001）。接受 TPE 的 ITP 患者的合并症发生率较高（50%），平均住院时间明显长于未接受 TPE 的患者（P<.001）。在这项具有全国代表性的 2010 年至 2014 年研究中，约 0.6%的 ITP 患者因 TPE 作为主要诊断而住院。TPE 用于治疗基础疾病严重程度最高的患者，且合并症发生率较高。
