Combo of blood biomarkers can help predict risk of death in TTP
New model could guide clinicians in decision-making for hospitalized patients
A combination of blood biomarkers can help predict the short-term risk of death for people admitted to the hospital with thrombotic thrombocytopenic purpura (TTP), according to a report by two researchers in China.
The use of these blood biomarkers could guide clinicians in treatment decision-making for patients with the blood disorder, the scientists noted.
The duo identified four biomarkers, all related in some way to organ damage, that were significantly associated with an increased risk of death in people with TTP. The researchers used them to create a mortality prediction model with scores ranging from 0 to 4.
“The risk model incorporating … levels [of the four biomarkers] effectively predicted short-term mortality in patients with TTP,” the researchers wrote in detailing the findings of their retrospective study. “Patients with a score of 3 or higher required close monitoring and aggressive therapeutic intervention to mitigate mortality risk.”
The team said they “developed [this] novel mortality risk stratification model to guide clinical decision making, ultimately aiming to optimize patient outcomes through evidence-based risk-adapted management strategies.”
The study, “Prognostic value of laboratory biomarkers for mortality risk stratification in thrombotic thrombocytopenic purpura,” was published in the Annals of Hematology.
In TTP, small blood clots form in blood vessels, leading to organ damage. The condition is caused by a deficiency in the ADAMTS13 enzyme, which can arise from genetic mutations or autoimmune reactions.
Left untreated, TTP is fatal in about 90% of cases. However, available therapies can effectively control the disease and reduce mortality rates. Current guidelines recommend plasma exchange therapy and corticosteroids as standard first-line treatments. In some cases, antibody-based therapies, namely rituximab or Cablivi (caplacizumab-yhdp), may be added.
Early ID of high-risk TTP patients crucial to achieving best outcomes
Achieving the best possible outcomes, according to the researchers, relies on a prompt diagnosis and early identification of high-risk patients, so as to best guide treatment selection.
To that end, a research team from Tongji Medical College at Huazhong University of Science and Technology aimed to develop a new mortality risk stratification model to guide TTP clinical decision-making. To do so, they retrospectively analyzed clinical and laboratory data from 106 patients with TTP who had been admitted to their hospital between 2016 and 2025.
Over approximately one month, 45 people died and 61 survived, the data showed. The individuals who survived were significantly younger than those who died. Surviving patients also experienced altered consciousness as a TTP symptom less frequently, had more extended hospital stays, and were more likely to receive rituximab in combination with standard TTP treatment.
Several blood biomarkers were significantly elevated in people who died compared with those who survived. The four with the strongest relationship to survival were cardiac troponin 1 (cTnI), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), and indirect bilirubin (IBIL).
BUN is a biomarker of kidney dysfunction, while cTnI indicates heart damage. LDH is a standard general marker of red blood cell destruction and tissue damage, while IBIL also indicates red blood cell destruction.
The team noted that ADAMTS13 activity itself did not differ significantly between the two groups.
According to the scientists, this suggests that enzyme deficiency itself is not the driver of acute mortality in TTP. “Instead, ‘second-strike’ mechanisms of organ damage … may play a more critical role,” the team wrote.
Cutoff values for risk of death determined for each blood biomarker
The researchers identified cutoff values for each of the four biomarkers. Patients with levels above the cutoff had a significantly higher mortality risk than those below it, per the team.
These biomarkers were then used to develop a TTP mortality risk model, with scores ranging from 0-4, which the team applied to the patient pool.
Mortality rates were lowest in people with scores of 0-1 (21.3%) and progressively increased to 39.1% with a score of 2, and to 60.9% with a score of 3. The mortality rate for patients with a score of 4 was 92.3%. For every 1-point increase in risk score, the odds of death increased by more than twofold, the data showed.
The model also had a strong predictive performance when tested in an external group of patients.
This study underscores the critical role of organ damage monitoring in TTP management and provides an evidence-based foundation for improving patient outcomes.
The scientists noted a critical need for early intensive therapy for people in high-risk groups, notably individuals with a score of 3 or 4, who had an “alarmingly high” mortality rate. Such individuals may benefit from the addition of antibody-based therapies like Cablivi or rituximab to standard care, the team noted.
“This study underscores the critical role of organ damage monitoring in TTP management and provides an evidence-based foundation for improving patient outcomes,” the researchers wrote.
Meanwhile, the duo noted that individuals at a lower risk of death can avoid unnecessary or prolonged first-line treatment, which would be a benefit of using the new model.
According to the authors, all patients should undergo close biomarker monitoring so treatment can be adjusted as needed.
The researchers made their risk score calculator available online. A physician can enter the blood levels of the four biomarkers, and the template will automatically generate a score, estimate the corresponding mortality risk, and provide relevant clinical recommendations.
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