Health
Validation study confirms prognostic value of MITS in TTP
Prognostic tool used to calculate mortality risk for hospitalized patients thrombotic thrombocytopenic purpura (TTP) is effective in characterizing individual patient mortality risk, according to what is believed to be the first external validation study of the tool.
this report, was announced in blood transfusion medicineTTP score (MITS) mortality was found to have an area under the curve of the receiving operator letter of 71%, similar to the 78.6% reported in the original derived study.
TTP can occur either congenital or acquired, but in both cases it is essential that the patient is treated, the study authors noted.
“Untreated TTP is devastating and early recognition and prompt treatment initiation are needed to reduce mortality,” they said.
Historically, therapeutic plasmapheresis has been the go-to treatment for diseases characterized by deficiency of the von Willebrand factor-cleaving protease ADAMTS13. However, in recent years, the authors state that the anti-von Willebrand factor nanobody capsizumab (Cablivi) has become first-line therapy for many patients.
However, the need to quickly identify high-risk patients remains. The MITS system was originally developed to predict hospital mortality in patients undergoing plasmapheresis. Scoring tools incorporate factors such as platelet transfusion, cerebral ischemia, intracranial hemorrhage, age, and renal failure. Patients with high scores despite plasmapheresis may require additional treatment, such as caplacizumab, the authors said.
Still, MITS has become an important part of treatment since it was first published in a 2016 study, but has yet to conduct external validation studies to confirm the tool’s effectiveness, the researchers said. I’m here.
They used the National Inpatient Sample Database to identify 4589 people hospitalized with TTP between 2016 and 2019, incorporated univariate and multivariate analyzes using the parameters of the MITS score, and analyzed them. was correlated with prognosis.
Researchers found that women, Caucasians, and those over the age of 60 had higher all-cause mortality than other patients. They found that both the variables included in the MITS and the MITS score itself correlated with mortality.
“Among the various clinical factors included in this study, arterial thrombosis and central nervous system bleeding carry the higher risk. [odds ratio] (3.17 and 2.93, respectively), are associated with worse outcomes when compared to other clinical variables included in the scoring schema,” they noted. “This increased risk justifies the discrete value of 3 assigned to each clinical variable in the scoring system.”
They found the MITS score to be an effective prognostic tool, but other parameters may also be useful, the authors say. For example, parameters such as type of immunosuppression, comorbidities, and time from admission to first plasmapheresis could be important factors in determining patient risk, they said. However, investigating these parameters may require more data than is available in this dataset, they said.
Until then, they said their validation studies showed that MITS could play an important role in guiding patient care.
“The existence of highly effective treatments in otherwise life-threatening diseases justifies early risk stratification to prevent death, and MITS is a valuable clinical tool that may guide that process. ‘ they concluded.
reference
Andanamala H, Brunton N, Pai R, Sostin O. Mortality review in thrombotic thrombocytopenic purpura score: an externally validated study. transfer medPublished online January 27, 2023. doi:10.1111/tme.12956
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