Goel et al developed a score for predicting mortality in a patient with thrombotic thrombocytopenic purpura (TTP). This can help to identify a high risk patient who may benefit from more aggressive or novel therapies. The authors are from the Johns Hopkins University in Baltimore.
Patient selection: TTP
Parameters:
(1) age in years
(2) arterial thrombosis
(3) central nervous system (CNS) bleed
(4) ischemic stroke
(5) myocardial infarction (AMI)
(6) renal failure (acute or chronic, including need for hemodialysis)
(7) platelet transfusion
|
Parameter |
Finding |
Points |
|
age in years |
< 60 years |
0 |
|
|
>= 60 years |
2 |
|
arterial thrombosis |
absent |
0 |
|
|
present |
3 |
|
CNS bleed |
absent |
0 |
|
|
present |
3 |
|
ischemic stroke |
absent |
0 |
|
|
present |
1 |
|
AMI |
absent |
0 |
|
|
present |
1 |
|
renal failure |
absent |
0 |
|
|
present |
1 |
|
platelet transfusion |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the mortality.
|
Score |
In-Hospital Mortality |
|
0 |
0.7% |
|
1 |
5.4% |
|
2 |
8.3% |
|
3 |
19.6% |
|
4 |
26.7% |
|
5 |
36.4% |
|
6 |
60% |
|
7 to 12 |
> 60% |
where:
• The number of cases with a score >= 7 was too low for accurate prediction.
Performance:
• The score was predictive of 79% of deaths.
Specialty: Hematology Oncology, Clinical Laboratory
