In:
Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 10 ( 2021-10), p. e931-e940
Abstract:
To describe short- and long-term neurologic prognosis of patients with thrombotic thrombocytopenic purpura and to identify clusters associated with evolution. DESIGN: Prospective French cohort. SETTING: ICU in a reference center. PATIENTS: All consecutive patients with newly diagnosed thrombocytopenic purpura. INTERVENTION: Comprehensive clinical, biological, and radiological evaluation at admission. Neurocognitive recovery was assessed using Glasgow Outcome Scale (range 1–5, with 1 representing death and 5 representing no or minimal neurologic deficit). MEASUREMENTS AND MAIN RESULTS: Among the 130 newly diagnosed patients with thrombocytopenic purpura, 108 (83%; age 43 [30–52]; 73% women) presented with neurologic signs, including headaches (51%), limb weakness, paresthesia, and/or aphasia (49%), pyramidal syndrome (30%), decreased consciousness (20%), seizure (19%), cognitive impairment (34%), cerebellar syndrome (18%), and visual symptoms (20%). A hierarchical cluster analysis identified three distinct groups of patients. Cluster 1 included younger patients (37 [27–48], 41 [32–52] , and 48 [35–54], in clusters 1, 2 and 3, respectively; p = 0.045), with a predominance of headaches (75%, 27%, and 36%; p 〈 0.0001). Cluster 2 patients had ataxic gait and cerebellar syndrome (77%, 0%, and 0%; p 〈 0.0001) and dizziness (50%, 0%, and 0%; p 〈 0.0001). Cluster 3 included patients with delirium (36%, 0%, and 9%; p 〈 0.0001), obtundation (58%, 0%, and 24%; p 〈 0.0001), and seizure (36%, 0%, and 14%; p 〈 0.0001). Acute kidney injury was 32%, 68%, and 77%, in clusters 1, 2, and 3, respectively ( p 〈 0.0001). The three clusters did not differ for other biological or brain imaging. After a median follow-up of 34 months (12–71 mo), 100 patients (93%) were alive with full neurocognitive recovery (i.e., Glasgow Outcome Scale score 5) in 89 patients (89%). Patients from cluster 1 more frequently exhibited full recovery (Glasgow Outcome Scale score of 5) compared with clusters 2 and 3, (44 [98%], 13 [65%] , and 21 [60%] at 3 mo; p 〈 0.0001), (44 [100%], 15 [68%] , and 23 [69%] at 6 mo; p 〈 0.0001), and (40 [100%], 15 [79%] , and 20 [57%] at 1 yr; p 〈 0.0001). CONCLUSIONS: Initial clinical neurologic evaluation in thrombocytopenic purpura patients distinguishes three groups of patients with different clinical and functional outcomes.
Type of Medium:
Online Resource
ISSN:
0090-3493
DOI:
10.1097/CCM.0000000000005164
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
2034247-0
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