title: Outcome of severe adult thrombotic microangiopathies in the intensive care unit.
abstract: OBJECTIVE
  Thrombotic microangiopathies, namely thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, are uncommon microvascular occlusive diseases. Despite the dramatic improvement in the outcome by exogenous plasma supply, either through plasma infusion or through plasma exchange, patients frequently require support in the intensive care unit. In the present study, we evaluated the outcome of a large cohort of patients with severe thrombotic microangiopathies.
  
  
  METHODS
  A retrospective multicenter study from January 1998 to June 2001.
  
  
  METHODS
  Fourteen French university hospital medical intensive care units.
  
  
  METHODS
  Sixty three adult patients with severe thrombotic microangiopathies.
  
  
  RESULTS
  Of the 63 patients, 19 had a clinical presentation of thrombotic thrombocytopenic purpura, 18 had hemolytic uremic syndrome and 26 had combined neurologic and renal failures. Infections were the main etiology associated with thrombotic microangiopathies. The mortality rate was 35%. Of the survivors, all achieved complete remission. Whereas neurologic failure assessed through the Glasgow coma scale was an independent predictor of mortality [HR=0.845 (CI 95%: 0.759-0.940), P=0.002], renal impairment did not appear to be an adverse prognostic factor. The use of plasma exchange was independently associated with survival [HR=0.269 (CI 95%: 0.104-0.691), P=0.006].
  
  
  CONCLUSIONS
  Thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with high mortality. Neurologic impairment appears to be the main adverse prognostic factor correlated to mortality, and the study confirms the importance of plasma exchange in the treatment of high-risk patients.
authors.affiliation: Medical Intensive Care Unit Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg Saint-Jacques, 75679 Paris, France. frederic.pene@cch.ap-hop-paris.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pene
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.forename: Marc
authors.initials: M
authors.lastname: Auburtin
authors.forename: Delphine
authors.initials: D
authors.lastname: Moreau
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Farhad
authors.initials: F
authors.lastname: Heshmati
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
mesh_terms: D000328:Adult; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006463:Hemolytic-Uremic Syndrome / Q000145:classification / Q000401:mortality / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010951:Plasma Exchange; D011379:Prognosis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000145:classification / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome