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Du P, Cristarella T, Goyer C, Moride Y. A Systematic Review of the Epidemiology and Disease Burden of Congenital and Immune-Mediated Thrombotic Thrombocytopenic Purpura. J Blood Med 2024; 15:363-386. [PMID: 39161536 PMCID: PMC11330749 DOI: 10.2147/jbm.s464365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024] Open
Abstract
Congenital (cTTP) and immune-mediated (iTTP) thrombotic thrombocytopenic purpura are serious and rare clotting disorders resulting from a deficiency in the ADAMTS13 enzyme. A systematic review was conducted using the Ovid® MEDLINE & Embase databases to synthesize the epidemiology and burden of cTTP and iTTP worldwide (from January 1, 2010, to February 6, 2020, with an update that covered the period January 1, 2020-February 11, 2022). Outcomes of interest were incidence and prevalence of TTP, incidence of acute episodes, mortality, burden of illness (eg complications, healthcare utilization, patient-reported outcomes) and disease management. A total of 221 eligible observational studies were included. The incidence rate of acute episodes ranged from 0.19-0.35 person-years in adult patients with cTTP, and 1.81-3.93 per million persons per year for iTTP in the general population. Triggers of acute episodes were similar for cTTP and iTTP, with pregnancy and infection the most commonly observed. Exacerbation in patients with iTTP varied widely, ranging from 2.4-63.1%. All-cause mortality was observed in 0-13.4% of patients with cTTP, across studies and follow-up periods, and in 1.1% (median follow-up: 0.4 years) to 18.8% (1 year) of patients with iTTP during acute episodes. Cardiovascular, renal, and neurological disease were common complications. TTP also led to work disturbances, feelings of anxiety and depression, and general activity impairment. TTP treatment regimens used were generally reflective of current treatment guidelines. The evidence identified describes a high patient burden, highlighting the need for effective treatment regimens leading to improvements in outcomes. Considerable evidence gaps exist, particularly for disease epidemiology, patient-reported outcomes, costs of disease management, and associated healthcare resource utilization. This review may help increase disease awareness and highlights the need for additional real-world studies, particularly in geographical regions outside the United States and Western Europe.
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Affiliation(s)
- Ping Du
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | | | - Yola Moride
- YolaRX Consultants Inc., Montreal, QC, Canada
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Abou-Ismail MY, Zhang C, Presson AP, Chaturvedi S, Antun AG, Farland AM, Woods R, Metjian A, Park YA, de Ridder G, Gibson B, Kasthuri RS, Liles DK, Akwaa F, Clover T, Kreuziger LB, Sridharan M, Go RS, McCrae KR, Upreti HV, Gangaraju R, Kocher NK, Zheng XL, Raval JS, Masias C, Cataland SR, Johnson AD, Davis E, Evans MD, Mazepa M, Lim MY. A machine learning approach to predict mortality due to immune-mediated thrombotic thrombocytopenic purpura. Res Pract Thromb Haemost 2024; 8:102388. [PMID: 38651093 PMCID: PMC11033197 DOI: 10.1016/j.rpth.2024.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
Background Mortality due to immune-mediated thrombotic thrombocytopenic purpura (iTTP) remains significant. Predicting mortality risk may potentially help individualize treatment. The French Thrombotic Microangiopathy (TMA) Reference Score has not been externally validated in the United States. Recent advances in machine learning technology can help analyze large numbers of variables with complex interactions for the development of prediction models. Objectives To validate the French TMA Reference Score in the United States Thrombotic Microangiopathy (USTMA) iTTP database and subsequently develop a novel mortality prediction tool, the USTMA TTP Mortality Index. Methods We analyzed variables available at the time of initial presentation, including demographics, symptoms, and laboratory findings. We developed our model using gradient boosting machine, a machine learning ensemble method based on classification trees, implemented in the R package gbm. Results In our cohort (n = 419), the French score predicted mortality with an area under the receiver operating characteristic curve of 0.63 (95% CI: 0.50-0.77), sensitivity of 0.35, and specificity of 0.84. Our gradient boosting machine model selected 8 variables to predict acute mortality with a cross-validated area under the receiver operating characteristic curve of 0.77 (95% CI: 0.71-0.82). The 2 cutoffs corresponded to sensitivities of 0.64 and 0.50 and specificities of 0.76 and 0.87, respectively. Conclusion The USTMA Mortality Index was acceptable for predicting mortality due to acute iTTP in the USTMA registry, but not sensitive enough to rule out death. Identifying patients at high risk of iTTP-related mortality may help individualize care and ultimately improve iTTP survival outcomes. Further studies are needed to provide external validation. Our model is one of many recent examples where machine learning models may show promise in clinical prediction tools in healthcare.
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Affiliation(s)
- Mouhamed Yazan Abou-Ismail
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Angela P. Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Shruti Chaturvedi
- The Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ana G. Antun
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Andrew M. Farland
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ryan Woods
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ara Metjian
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Yara A. Park
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gustaaf de Ridder
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Geisinger Medical Laboratories, Danville, Pennsylvania, USA
| | - Briana Gibson
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Raj S. Kasthuri
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Darla K. Liles
- Department of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Frank Akwaa
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | | | - Lisa Baumann Kreuziger
- Versiti, Milwaukee, Wisconsin, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meera Sridharan
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald S. Go
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Keith R. McCrae
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Harsh Vardhan Upreti
- The Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Radhika Gangaraju
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicole K. Kocher
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - X. Long Zheng
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Institute of Reproductive Medicine and Developmental Sciences, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jay S. Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Spero R. Cataland
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Andrew D. Johnson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth Davis
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael D. Evans
- Clinical & Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marshall Mazepa
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ming Y. Lim
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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Soares Ferreira Junior A, Pinheiro Maux Lessa M, Boyle SH, Sanborn K, Kuchibhatla M, Onwuemene OA. In patients with suspected immune TTP, admission source impacts hospital length of stay and time to therapeutic plasma exchange impacts clinical outcomes. Thromb Res 2023; 227:34-39. [PMID: 37210956 DOI: 10.1016/j.thromres.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/24/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION When immune thrombotic thrombocytopenic purpura (TTP) is suspected, outcomes are impacted by time to therapeutic plasma exchange (TPE). We evaluated the impact of time to TPE on outcomes in suspected TTP cases admitted through the Emergency Department (ED) vs. transferred from another facility (Transfer). MATERIALS AND METHODS In a retrospective analysis of the National Inpatient Sample, we examined the association between TTP outcomes and admission source (ED vs. Transfer) for the primary outcome of time to TPE. A second stratified analyses within each analytic group examined the association of time to TPE (<1 day, 1 day, 2 days, and >2 days) and outcomes for the composite outcome of mortality, major bleeding and thrombosis. RESULTS Of 1195 cases, 793 (66 %) were admitted through the ED and 402 (34 %) were transferred. Compared to ED cases, Transfers had a longer hospital length of stay (14.69 vs. 16.65 days, p = 0.0060). For ED cases, TPE after >2 days was associated with higher odds of the composite outcome (OR = 1.68 95 % CI: 1.11-2.54; p = 0.0150) and mortality (OR = 3.01 95 % CI: 1.38-6.57; p = 0.0056). For Transfers, TPE on day 2 was associated with higher odds of the composite outcome (OR = 3.00 95 % CI: 1.31-6.89; p = 0.0096) and mortality (OR = 4.95 95 % CI: 1.12-21.88; p = 0.0350). CONCLUSIONS In suspected TTP admitted through the ED or transferred, there was no significant difference in time to TPE. A longer time to TPE was associated with worse outcomes. Future studies should evaluate strategies to decrease initial time to TPE.
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Affiliation(s)
| | - Morgana Pinheiro Maux Lessa
- Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Kate Sanborn
- Duke Biostatistics, Epidemiology and Research Design Core, Duke University School of Medicine, Durham, NC, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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Li M, Guo B, Wang X, Zhang Y. Risk factors of renal trauma in children with severe Henoch-Schonlein purpura and effect of mycophenolate mofetil on pediatric renal function. Transl Pediatr 2021; 10:3166-3174. [PMID: 35070830 PMCID: PMC8753466 DOI: 10.21037/tp-21-493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Renal trauma (RT) is a common feature in children with severe Henoch-Schonlein purpura (HSP), which can elevate the chance of recurrence and trigger end-stage renal disease. The risk factors of RT in children with HSP were explored and research was conducted on relevant treatment methods. METHODS A total of 120 child patients with severe HSP admitted to our hospital from January 2019 to January 2020 were selected as the research cohort, and divided into a RT group (n=45) and RT-free group (n=75) according to their condition to analyze the risk factors inducing RT in pediatric patients, and mycophenolate mofetil therapy was given to both participant groups to compare their renal function indicators, immune function indicators, and adverse reaction rates (ARR) after treatment. RESULTS Recurrent rash, adenovirus infection, respiratory virus infection, D-dimer level, leukocyte level, urinary albumin (UA) level, and platelet level were the risk factors of RT affecting severe HSP child patients. After treatment, the renal function indicators and immune indicators of participants in both groups were significantly better than those before treatment (P<0.05), and these indicators of the RT-free group were significantly better than the RT group after treatment (P<0.05). All participants did not experience serious adverse reactions, and no significant difference was presented when comparing the ARR between the 2 groups (P>0.05). CONCLUSIONS Recurrent rash, adenovirus infection, respiratory virus infection, D-dimer level, leukocyte level, UA level, and platelet level are the risk factors of RT affecting children with severe HSP, and mycophenolate mofetil can improve the renal function in pediatric patients and enhance their immunity, and is thus worthy of promotion in practice.
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Affiliation(s)
- Minhui Li
- Department of Pediatrics Internal Medicine, Dongying Municipal Children's Hospital, Dongying, China
| | - Binbin Guo
- Department of Nephrology, Shengli Oilfield Central Hospital, Dongying, China
| | - Xue Wang
- Department of Pediatrics Internal Medicine Shengli Oilfield Central Hospital, Dongying, China
| | - Yingying Zhang
- Department of Pediatrics Internal Medicine Shengli Oilfield Central Hospital, Dongying, China
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