Article Dans Une Revue Research and Practice in Thrombosis and Haemostasis Année : 2022

Immune-mediated thrombotic thrombocytopenic purpura prognosis is affected by blood pressure

1 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
2 AP-HP - Hopital Saint-Louis [AP-HP]
3 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
4 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
5 Hôpital Albert Calmette
6 CHU Amiens-Picardie
7 Hôpital Maison Blanche
8 Hôpital Charles Nicolle [Rouen]
9 CHU Tenon [AP-HP]
10 Hôpital Cochin [AP-HP]
11 Service de Néphrologie-transplantation-dialyse [Bordeaux]
12 CHU Gabriel Montpied [Clermont-Ferrand]
13 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
14 Centre Hospitalier Le Mans (CH Le Mans)
15 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
16 Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
17 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
18 AP-HP - Hôpital Antoine Béclère [Clamart]
19 Hôpital Henri Mondor
20 EHESP - École des Hautes Études en Santé Publique
21 Irset - Institut de recherche en santé, environnement et travail
22 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
23 Centre hospitalier [Valenciennes, Nord]
24 CHU Montpellier = Montpellier University Hospital
25 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
26 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
27 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
28 CH E.Muller Mulhouse - Centre Hospitalier Emile Muller [Mulhouse]
29 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
30 HEGP - Hôpital Européen Georges Pompidou [APHP]
31 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
32 CHU Saint-Antoine [AP-HP]
Elie Azoulay
Claire Presne
Khalil El Karoui
Anne Charvet‐rumpler
  • Fonction : Auteur
Paul Coppo

Résumé

BACKGROUND: The prevalence, prognostic role, and diagnostic value of blood pressure in immune-mediated thrombotic thrombocytopenic purpura (iTTP) and other thrombotic microangiopathies (TMAs) remain unclear. METHODS: Using a national cohort of iTTP (n = 368), Shigatoxin-induced hemolytic uremic syndrome (n = 86), atypical hemolytic uremic syndrome (n = 84), and hypertension-related thrombotic microangiopathy (n = 25), we sought to compare the cohort’s blood pressure profile to assess its impact on prognosis and diagnostic performances. RESULTS: Patients with iTTP had lower blood pressure than patients with other TMAs, systolic (130 [interquartile range (IQR) 118-143] vs 161 [IQR 142-180] mmHg) and diastolic (76 [IQR 69-83] vs 92 [IQR 79-105] mmHg, both p < 0.001). The best threshold for iTTP diagnosis corresponded to a systolic blood pressure <150 mmHg. iTTP patients presenting with hypertension had a significantly poorer survival (hazard ratio 1.80, 95% confidence interval 1.07-3.04), and this effect remained significant after multivariable adjustment (hazard ratio = 1.14, 95% confidence interval 1.00-1.30). Addition of a blood pressure criterion modestly improved the French clinical score to predict a severe A disintegrin and metalloprotease with thrombospondin type 1 deficiency in patients with an intermediate score (i.e., either platelet count <30 × 10(9)/L or serum creatinine <200 µM). CONCLUSIONS: Elevated blood pressure at admission affects the prognosis of iTTP patients and may help discriminate them from other TMA patients. Particular attention should be paid to blood pressure and its management in these patients.

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hal-03714637 , version 1 (06-06-2023)

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Adrien Joseph, Martin Eloit, Elie Azoulay, Gilles Kaplanski, François Provot, et al.. Immune-mediated thrombotic thrombocytopenic purpura prognosis is affected by blood pressure. Research and Practice in Thrombosis and Haemostasis, 2022, 6 (4), pp.e12702. ⟨10.1002/rth2.12702⟩. ⟨hal-03714637⟩
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