Hu Lingling, Wang Jing, Jin Xiaxia, Lu Guoguang, Fang Meidan, Shen Jian, Tung Tao-Hsin, Shen Bo
Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China.
Key Laboratory of System Medicine and Precision Diagnosis and Treatment of Taizhou, Taizhou, China.
Diabetol Metab Syndr. 2024 Feb 15;16(1):44. doi: 10.1186/s13098-024-01275-2.
Thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy with a rapid progression and high mortality rate. We aimed to explore early risk factors for mortality in patients with TTP.
We conducted a retrospective analysis of 42 TTP patients that were admitted to our hospital between 2000 and 2021, with a median age of 49 (29-63) years. Risk factors for mortality were evaluated using multivariate logistic regression. Receiver operating characteristic curve analysis was used to determine the cut-off value of glucose for predicting mortality in patients, which was validated by comparison to a similar cohort in the published literature.
Elevated glucose level and reduced red blood cells (RBC) counts were risk factors for mortality in patients with TTP (glucose, odds ratio and 95% confidence interval: 2.476 [1.368-4.484]; RBC, odds ratio and 95% confidence interval: 0.095 [0.011-0.799]). The area under the curve of glucose was 0.827, and the cut-off value was 9.2 mmol/L, with a sensitivity of 75.0% and specificity of 95.8%. A total of 26 cases from the validation cohort had a sensitivity of 71.0% and a specificity of 84.0%. The change trends of the TTP-related laboratory indices differed during hospitalization.
Hyperglycemia at admission and unstable blood glucose levels during hospitalization may be potential predictors of mortality for TTP patients. The improved prognosis was associated with the recovery of platelet counts and a significant decrease in serum lactate dehydrogenase after five days of treatment.
血栓性血小板减少性紫癜（TTP）是一种罕见的血栓性微血管病，进展迅速，死亡率高。我们旨在探讨TTP患者死亡的早期危险因素。
我们对2000年至2021年期间入住我院的42例TTP患者进行了回顾性分析，患者中位年龄为49（29 - 63）岁。使用多因素逻辑回归评估死亡危险因素。采用受试者工作特征曲线分析确定预测患者死亡的血糖临界值，并通过与已发表文献中的类似队列进行比较来验证。
血糖水平升高和红细胞（RBC）计数降低是TTP患者死亡的危险因素（血糖，比值比和95%置信区间：2.476 [1.368 - 4.484]；RBC，比值比和95%置信区间：0.095 [0.011 - 0.799]）。血糖的曲线下面积为0.827，临界值为9.2 mmol/L，敏感性为75.0%，特异性为95.8%。验证队列中的26例患者敏感性为71.0%，特异性为84.0%。住院期间TTP相关实验室指标的变化趋势有所不同。
入院时高血糖和住院期间血糖水平不稳定可能是TTP患者死亡的潜在预测因素。预后改善与血小板计数恢复以及治疗5天后血清乳酸脱氢酶显著降低有关。
