title: Time course of organ dysfunction in thrombotic microangiopathy patients receiving either plasma perfusion or plasma exchange.
abstract: BACKGROUND
  Few studies have investigated adults with thrombotic microangiopathy (TMA) requiring intensive care unit (ICU) admission, and the treatment remains controversial.
  
  
  OBJECTIVE
  To describe causes, outcomes, prognostic factors, and daily organ-failure score changes in adults with TMA requiring ICU admission.
  
  
  METHODS
  A 3-yr single-center cohort study.
  
  
  METHODS
  The patients were 36 adults with TMA admitted to a teaching-hospital medical ICU between January 2000 and June 2003.
  
  
  RESULTS
  Of the 36 patients, 22 received plasma infusion and 15 underwent plasma exchange. All patients had anemia and thrombocytopenia at ICU admission, and 13 had neurologic impairment. Median creatinine clearance was 55.2 mL/min (interquartile range, 28.8-75.4). No patient had congenital TMA. Causative factors included microbiologically documented infection in 14 patients, allogeneic transplantation in 7 patients, and concomitant or subsequent systemic disease in 7 patients; 6 patients were human immunodeficiency virus-positive, 5 had drug-induced TMA, 2 were pregnant, and 2 had cancer. In 10 patients, no causative factors were identified. Plasma exchange was associated with a statistically significant decrease in hospital mortality (0 vs. 7 deaths; p < .001). Moreover, daily organ-failure scores were significantly lower in the plasma-exchange group from day 3 to day 9. Patients in the plasma-exchange group received a larger volume of plasma.
  
  
  CONCLUSIONS
  Plasma exchange may be associated with faster resolution of organ failure and with improved survival for patients with TMA requiring ICU admission.
authors.affiliation: Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Saint-Louis University Hospital, Paris, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiery
authors.forename: Magali
authors.initials: M
authors.lastname: Ciroldi
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.forename: Nathalie
authors.initials: N
authors.lastname: Parquet
authors.forename: Agnès
authors.initials: A
authors.lastname: Veyradier
authors.forename: Jean-Roger
authors.initials: JR
authors.lastname: Le Gall
authors.forename: Eric
authors.initials: E
authors.lastname: Oksenhendler
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D010949:Plasma; D010951:Plasma Exchange; D015985:Precipitating Factors; D012121:Respiration, Artificial; D012307:Risk Factors; D012720:Severity of Illness Index