title: Increased troponin I is associated with fatal outcome in acquired thrombotic thrombocytopenic purpura.
abstract: Thrombotic thrombocytopenic purpura (TTP) has >90% mortality without therapeutic plasma exchange (TPE). Despite TPE, approximately 10% of patients still die, presumably from cardiac ischemia. We sought clinical or laboratory parameters associated with death by reviewing the records of all patients hospitalized with acquired TTP in our institution for 10 years, and collect demographics and results for hemoglobin, platelet count, creatinine, lactate dehydrogenase, transaminases, total bilirubin, creatinine kinase (CK), CK-MB, and troponin I. Sixty-eight patients were admitted 88 times, and 11 died. Survivors and non-survivors were similar in terms of sex, ethnicity, thrombocytopenia, and degree of anemia at presentation, while the latter were older, had worse renal function and higher CK, CK-MB, and troponin I (univariate analysis). However, only troponin I remained significant on multivariate analyses. We propose that patients with TTP should be monitored with troponin I to detect significant myocardial ischemia that could predict death despite TPE.
authors.affiliation: Department of Pathology, University of Alabama at Birmingham (UAB), Birmingham, Alabama.
authors.forename: Jason
authors.initials: J
authors.lastname: Brazelton
authors.affiliation: Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Oster
authors.affiliation: Department of Pathology, University of Alabama at Birmingham (UAB), Birmingham, Alabama.
authors.forename: Brandi
authors.initials: B
authors.lastname: McCleskey
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jessica
authors.initials: J
authors.lastname: Fuller
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Jill
authors.initials: J
authors.lastname: Adamski
authors.affiliation: Department of Pathology, University of Alabama at Birmingham (UAB), Birmingham, Alabama.
authors.forename: Marisa B
authors.initials: MB
authors.lastname: Marques
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D011379:Prognosis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D019210:Troponin I / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form
keywords: TTP; cardiac ischemia; cardiac markers; death; troponin I