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Thrombotic thrombocytopenia purpura survivors may be at risk for poor health
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Survivors of thrombotic thrombocytopenia purpura had increased health complications and a higher mortality rate than individuals in the general population, according to study results.
The researchers suggested that minor cognitive abnormalities and relapse risk are among the few complications associated with recovery from acute episodes of thrombotic thrombocytopenic purpura (TTP). They aimed to investigate other possible complications in this population.
The study included 70 consecutive patients from Oklahoma TTP-HUS (hemolytic-uremic syndrome) Registry enrolled between 1995 and 2011. Eligible participants had ADAMTS13 activity <10% with their initial episode.
The 57 surviving patients underwent follow-up through 2012.
The researchers compared the prevalence of several factors in this patient population with expected values based on the US reference population. Those factors included BMI, glomerular filtration rate, urine albumin/creatinine ratio, hypertension, major depression, systemic lupus erythematosus and mortality risk.
The patient group had a median age of 39 years at initial diagnosis.
At the time of diagnosis, BMI and an observed 7% prevalence of systemic lupus erythematosus were greater in the study cohort than would be expected in the general population (P<.001). The rate of hypertension (19%) in the study group was no different than in the comparator (P=.463).
During analysis in 2011-2012, hypertension was 40% in the patient cohort compared with an expected 23% for the general population (P=.013). The rate of major depression also was higher in the study group (19% vs. 6%; P=.005).
At their last follow-up, the glomerular filtration rate of all 57 patients and the urine albumin/creatinine ratio calculated for 37 of the patients were not different from expected values, researchers wrote.
The 19% mortality rate also was higher than expected compared with reference populations (P<.05).
“Recognition of increased morbidity and mortality among patients following recovery suggests that TTP may, in some patients, be a more chronic disorder rather than a disorder of acute episodes and complete recovery,” the researchers wrote. “These observations suggest that recovery from an acute episode of TTP is not a conclusion of care, but rather the beginning of a requirement for long-term health care. The occurrence of obesity, hypertension, depression, and systemic lupus erythematosus in these patients highlights issues of public health and primary care in addition to the need for investigation to understand the continuing health problems associated with TTP survivorship.”
Disclosure: The researchers report consulting roles with Baxter for the development of rADAMTS13, a potential treatment for TTP, as well as a consulting role for Alexion.
Perspective
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Harry S. Jacob, MD, FRCPath(Hon)
The marked increase in major depression in "recovered" TTP patients is particularly evocative. Might altered platelet/serotonin kinetics be involved? If so, occult continuous platelet activation may be more chronic than previously considered.
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