Thromb Haemost 2021; 121(05): 565-572
DOI: 10.1055/s-0040-1720974
Coagulation and Fibrinolysis

Clinical Features and Outcome of Thrombotic Microangiopathies: Comparison between Patients with and without Malignancy

Andry Van de Louw
1  Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Austin Cohrs
2  Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Douglas Leslie
2  Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
› Author Affiliations
Funding This study was funded by the Department of Medicine, Penn State Health Milton S. Hershey Medical Center.

Abstract

Thrombotic microangiopathy (TMA) is an uncommon complication of cancers, related to the malignancy itself, antineoplastic drugs, or hematopoietic stem cell transplant. It was reported mostly as case series but large data are lacking. We used the large U.S. MarketScan database to compare TMA between patients with and without malignancy. Adult patients hospitalized between 2005 and 2014 with a diagnosis of TMA were included; cancer patients were defined by a diagnosis of cancer within 1 year prior to or during the admission with TMA. Associated inpatient diagnoses, procedures, hospital mortality, and long-term survival were collected. We included 3,227 patients; 617 (19.1%) had cancer (age 54 [44–60] years, 58% female), which was a new diagnosis for 23% of patients. Two-thirds of cancer patients had solid tumors (mostly pancreas, lung, breast, colorectal, and hepatobiliary, half of them metastatic) and one-third had hematological malignancies (lymphoma, acute leukemia, and multiple myeloma); TMA patients with cancer were older, more often men, had more noncancer-related comorbidities, and developed more sepsis and coagulopathy than TMA patients without cancer. Hospital mortality was significantly higher in cancer patients (16.6% vs. 6.1%, p < 0.001) and reached 30% in transplant recipients; malignancy was an independent risk factor for hospital mortality in multivariate analysis and sensitivity analyses excluding patients with metastases or patients who did not undergo plasmapheresis led to similar results. Malignancy was also associated with decreased long-term survival.

Supplementary Material



Publication History

Received: 29 July 2020

Accepted: 21 September 2020

Publication Date:
13 November 2020 (online)

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