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Cardiac troponin-I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center.
J Thromb Haemost. 2014 Nov 18;
Authors: Benhamou Y, Boelle PY, Baudin B, Ederhy S, Gras J, Galicier L, Azoulay E, Provôt F, Maury E, Pène F, Mira JP, Wynckel A, Presne C, Poullin P, Halimi JM, Delmas Y, Kanouni T, Seguin A, Mousson C, Servais A, Bordessoule D, Perez P, Hamidou M, Cohen A, Veyradier A, Coppo P
Abstract
Background. Cardiac involvement is a major cause of mortality in thrombotic thrombocytopenic purpura (TTP). However, diagnosis remains underestimated and delayed due to sub-clinical injuries. Cardiac troponin-I (cTnI) on admission could improve early diagnosis of cardiac involvement and have a prognostic value. Objectives. To assess the predictive value of cTnI-I in TTP for death or refractoriness. Patients/Methods. The study involved a prospective cohort of adult TTP patients with acquired severe ADAMTS13 deficiency (<10%) and included in the registry of the French reference center for thrombotic microangiopathies. Centralized cTnI measurements were performed from frozen serum on admission. Results. Between January, 2003 and December, 2011, 133 patients with TTP (mean age, 48±17 year-old) had available cTnI measurement on admission. Thirty-two patients (24%) had clinical and/or electrocardiogram features. Nineteen (14.3%) had cardiac symptoms, mainly congestive heart failure and myocardial infarction. Electrocardiogram changes, mainly repolarization disorders, were present in 13 cases. An increased cTnI (>0.1μg/L) was present in 78 patients (59%), of whom 46 (59%) had no clinical cardiac involvement. Main outcomes were death (25%) and refractoriness (17%). Age (P=0.02) and cTnI level (P=0.002) showed the greatest impact on survival. A cTnI level >0.25 μg/L was the only independent factor in predicting death (Odds-ratio [OR] 2.87; 95% confidence interval [CI]: 1.13-7.22; P=0.024) and/or refractoriness (OR 3.03; 95%CI: 1.27-7.3; P=0.01). Conclusions. CTnI >0.25 μg/L at presentation in TTP appears as an independent factor associated with a threefold increase in death risk or refractoriness. Therefore, cTnI levels should be considered as part of prognostic indicator in patients diagnosed with TTP. This article is protected by copyright. All rights reserved.
PMID: 25403270 [PubMed - as supplied by publisher]