Treatment delays, small hospital size negatively impact TTP outcomes: Study
Being hospitalized on weekends poses no increased risk compared to weekdays
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People with thrombotic thrombocytopenic purpura (TTP) who are hospitalized on weekends face no increased risk of worse outcomes than those admitted on weekdays, according to a large analysis of U.S. inpatient data.
On the contrary, delayed treatment with therapeutic plasma exchange (TPE) — a standard therapy — and hospitalization in smaller hospitals were identified as key risk factors for worse in-hospital outcomes.
“These results highlight the importance of early intervention, reinforcing the need for healthcare systems to prioritize timely TPE administration,” researchers wrote.
The study, “Impact of Day of Hospital Admission and Hospital Characteristics on Mortality in Thrombotic Thrombocytopenic Purpura,” was published in the Journal of Clinical Apheresis.
TPE replaces patient’s plasma to remove harmful antibodies
TTP is a rare blood disorder in which tiny clots form in small blood vessels, potentially damaging vital organs. In the most common form, immune-mediated TTP, the immune system attacks ADAMTS13, an enzyme that normally prevents excessive clotting.
Standard TTP treatments have dramatically improved patient outcomes, with survival rates after an acute TTP episode now exceeding 90% when therapy is started promptly. TPE, one of the main TTP treatments, replaces a patient’s plasma — the portion of blood without cells — with healthy donor plasma to remove harmful antibodies. Cablivi (caplacizumab-yhdp), which helps prevent blood clot formation by blocking a key clotting protein called von Willebrand factor, is approved for TTP in combination with TPE and immunosuppressive therapy.
Earlier research suggested that people admitted to the hospital with TTP on weekends had poorer clinical outcomes than those admitted during the week. Notably, hospital care on weekends has been associated with delays in care, lower quality, and reduced availability of specialized treatments, according to the investigators.
Since then, hospitals have expanded staffing, upgraded equipment, and worked to shorten the time to start TPE.
To evaluate the efficacy of such measures, researchers in the U.S. analyzed data collected between 2016 and 2019 from the National Inpatient Sample database. They used a recent risk tool — the Mortality in TTP Score (MITS) — to better account for patient-related risk factors.
Patients who died experienced longer delays before starting TPE
The analysis compared death rates for patients admitted on weekdays versus weekends. The team also assessed whether factors such as age, sex, race, hospital size, and insurance type might affect outcomes.
Over the four-year period, the researchers identified 3,725 hospitalizations for TTP in the U.S. Most patients were women (67.8%) and white (43.5%), and about a third (33.6%) were in the lowest household income quartile.
Overall, the in-hospital death rate was 6.2%. When the researchers compared weekend to weekday admissions, they found no association between day of admission and risk of death. Also, no differences between these groups were found regarding age (mean age was nearly 49 and nearly 48 years in the two groups, respectively), sex, income, insurance type, and hospital location.
Given the critical role of [therapeutic plasma exchange] in managing TTP, insufficient staffing and resource constraints in smaller hospitals may contribute to suboptimal patient outcomes. Addressing these challenges through targeted interventions and quality improvement initiatives is essential for reducing mortality rates and enhancing patient care.
In a multivariable analysis that accounted for several factors, patients who died tended to have higher MITS scores, were more often treated at small (less than 100 beds) or medium-sized (100 to 499 beds) hospitals, and experienced longer delays before starting TPE.
According to the findings, delays in therapy administration “beyond 2 days were associated with significantly worse outcomes, including increased mortality,” the researchers wrote.
Specifically, patients whose plasma exchange treatment was delayed between two and five days had 3.4 times higher odds of dying in the hospital, while those whose treatment was delayed more than five days faced 4.9 times higher odds of death.
“Given the critical role of TPE in managing TTP, insufficient staffing and resource constraints in smaller hospitals may contribute to suboptimal patient outcomes,” the researchers wrote. “Addressing these challenges through targeted interventions and quality improvement initiatives is essential for reducing mortality rates and enhancing patient care.”
