Predictors of acute ischemic cerebral lesions in immune-mediated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome

被引:2
作者
Neuman, Lisa [1 ]
Joseph, Adrien [2 ,3 ]
Bouzid, Raida [2 ]
Lescroart, Mickael [2 ,3 ]
Mariotte, Eric [2 ,3 ]
Ederhy, Stephane [2 ,4 ]
Tuffet, Sophie [2 ,5 ]
Baudel, Jean-Luc [2 ,6 ]
Benhamou, Ygal [2 ,7 ,9 ]
Galicier, Lionel [2 ,8 ]
Grange, Steven [2 ,9 ]
Provot, Francois [2 ,10 ]
Neel, Antoine [2 ,11 ]
Pene, Frederic [2 ,12 ,13 ]
Delmas, Yahsou [2 ,14 ]
Presne, Claire [2 ,15 ]
Poullin, Pascale [2 ,16 ]
Wynckel, Alain [2 ,17 ]
Perez, Pierre [2 ,18 ]
Barbet, Christelle [2 ,19 ]
Halimi, Jean-Michel [2 ,19 ]
Chatelet, Val'rie [2 ,20 ]
Rebibou, Jean-Michel [2 ,21 ]
Ojeda-Uribe, Mario [2 ,22 ]
Vigneau, C'cile [2 ,23 ]
Mesnard, Laurent [2 ,24 ]
Veyradier, AgnSs [2 ,25 ]
Azoulay, Elie [2 ,3 ]
Coppo, Paul [2 ,26 ,27 ,28 ,29 ]
Chabriat, Hugues
Prospective Multictr MATRISK study, Prospective Multictr M. A. T. R. I. S. K. study
机构
[1] Univ Paris, Hop Lariboisiere, Ctr NeuroVasc Translat, Ctr Reference CERVCO,Dept Neurol,GHU AP-HP Nord, Paris, France
[2] Ctr Reference Microangiopathies Thrombot CNR MAT, AP HP, Paris, France
[3] Hop St Louis, Med Intens Reanimat, AP HP, Paris, France
[4] Sorbonne Univ, St Antoine Hosp, AP HP, Dept Cardiol,GRC 27, F-75012 Paris, France
[5] Hop St Antoine, AP HP, Ctr Ressources Biol CRB APHP SU, Ctr Rech Clin CRCEST,Dept Clin Pharmacol,Clin Res, Paris, France
[6] Hop St Antoine, Assistance Publ Hop Paris AP HP, Serv Reanimat Med, 184 Rue Faubourg St-Antoine, F-75571 Paris 12, France
[7] Univ Normandie, Hop Univ Rouen, Dept Med Interne, Rouen, France
[8] Univ Paris, Serv Immunol Clin, CHU St Louis, Paris, France
[9] CHU Charles Nicolle, Serv Reanimat Medicale, Rouen, France
[10] Hop Albert Calmette, Serv Nephrol, Lille, France
[11] CHU Hotel Dieu, Serv Reanimat Medicale, Nantes, France
[12] APHP Ctr, Serv med intens reanimat, Hop Cochin, Paris, France
[13] Univ Paris, Paris, France
[14] CHU Bordeaux, Serv Nephrol, Bordeaux, France
[15] Hop Nord Amiens, Serv Nephrol, Amiens, France
[16] Hop Conception, Serv hemapherese & autotransfus, Marseille, France
[17] Hop Maison Blanche, Serv Nephrol, Reims, France
[18] CHU Nancy, Serv Reanimat Polyvalente, Nancy, France
[19] Hop Bretonneau & Clocheville, Serv Nephrol Hypertens, Dialyses, Transplantat Renale, Tours, France
[20] Normandie Univ, CHU Caen Normandie, Ctr Univ Malad Renales, UNICAEN, Caen, France
[21] CHU Dijon, Serv Nephrol, Dijon, France
[22] Grp Hosp Reg Mulhouse Sud Alsace GHRMSA, Serv Hematol & Therapie Cellulaire, Mulhouse, France
[23] Univ Rennes, Irset Inst Rech Sante Environm & Travail, Inserm, EHESP,UMR S 1085,CHU Rennes, F-35000 Rennes, France
[24] Hop Tenon, Urgences Nephrol & Transplantat Renale, Paris, France
[25] Hop St Antoine, Assistance Publ Hop Paris AP HP, Serv Biochim, F-75571 Paris 12, France
[26] Hop Lariboisiere, AP HP Paris, Serv Hematol Biol, Paris, France
[27] AP HP, Ctr Natl Reference Microangiopathies Thrombot, Serv Hematol, 184 Rue Faubourg St Antoine, F-75012 Paris, France
[28] Sorbonne Univ, Hop St Antoine, 184 Rue Faubourg St Antoine, F-75012 Paris, France
[29] INSERM UMRS 1138, Ctr Rech Cordeliers, Paris, France
关键词
Thrombotic thrombocytopenic purpura; Hemolytic uremic syndrome; Complications; Stroke; MRI; Acute infarcts; DISEASE;
D O I
10.1007/s00415-023-11830-y
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BackgroundThe immune form of thrombotic thrombocytopenic purpura (iTTP) and the hemolytic and uremic syndrome (HUS) are two major forms of thrombotic microangiopathy (TMA). Their treatment has been recently greatly improved. In this new era, both the prevalence and predictors of cerebral lesions occurring during the acute phase of these severe conditions remain poorly known.AimThe prevalence and predictors of cerebral lesions appearing during the acute phase of iTTP and Shiga toxin-producing Escherichia coli-HUS or atypical HUS were evaluated in a prospective multicenter study.MethodsUnivariate analysis was performed to report the main differences between patients with iTTP and those with HUS or between patients with acute cerebral lesions and the others. Multivariable logistic regression analysis was used to identify the potential predictors of these lesions.ResultsAmong 73 TMA cases (mean age 46.9 & PLUSMN; 16 years (range 21-87 years) with iTTP (n = 57) or HUS (n = 16), one-third presented with acute ischemic cerebral lesions on magnetic resonance imagery (MRI); two individuals also had hemorrhagic lesions. One in ten patients had acute ischemic lesions without any neurological symptom. The neurological manifestations did not differ between iTTP and HUS. In multivariable analysis, three factors predicted the occurrence of acute ischemic lesions on cerebral MRI: (1) the presence of old infarcts on cerebral MRI, (2) the level of blood pulse pressure, (3) the diagnosis of iTTP.ConclusionAt the acute phase of iTTP or HUS, both symptomatic and covert ischemic lesions are detected in one third of cases on MRI. Diagnosis of iTTP and the presence of old infarcts on MRI are associated with the occurrence of such acute lesions as well as increased blood pulse pressure, that may represent a potential target to further improve the therapeutic management of these conditions.
引用
收藏
页码:5023 / 5033
页数:11
相关论文
共 19 条
  • [1] Baseline NIH Stroke Scale score strongly predicts outcome after stroke - A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)
    Adams, HP
    Davis, PH
    Leira, EC
    Chang, KC
    Bendixen, BH
    Clarke, WR
    Woolson, RF
    Hansen, MD
    [J]. NEUROLOGY, 1999, 53 (01) : 126 - 131
  • [2] MMSE and MoCA in Parkinson's disease and dementia with Lewy bodies: a multicenter 1-year follow-up study
    Biundo, Roberta
    Weis, L.
    Bostantjopoulou, S.
    Stefanova, E.
    Falup-Pecurariu, C.
    Kramberger, M. G.
    Geurtsen, G. J.
    Antonini, A.
    Weintraub, D.
    Aarsland, D.
    [J]. JOURNAL OF NEURAL TRANSMISSION, 2016, 123 (04) : 431 - 438
  • [3] Brain lesions are most often reversible in acute thrombotic thrombocytopenic purpura
    Burrus, Tamika M.
    Wijdicks, Eelco F. M.
    Rabinstein, Alejandro A.
    [J]. NEUROLOGY, 2009, 73 (01) : 66 - 70
  • [4] Chaturvedi S, 2023, BLOOD, DOI 10.1182/
  • [5] COCKRELL JR, 1988, PSYCHOPHARMACOL BULL, V24, P689
  • [6] A regimen with caplacizumab, immunosuppression, and plasma exchange prevents unfavorable outcomes in immune-mediated TTP
    Coppo, Paul
    Bubenheim, Michael
    Azoulay, Elie
    Galicier, Lionel
    Malot, Sandrine
    Bige, Naike
    Poullin, Pascale
    Provot, Francois
    Martis, Nihal
    Presne, Claire
    Moranne, Olivier
    Benainous, Ruben
    Dossier, Antoine
    Seguin, Amelie
    Hie, Miguel
    Wynckel, Alain
    Delmas, Yahsou
    Augusto, Jean-Francois
    Perez, Pierre
    Rieu, Virginie
    Barbet, Christelle
    Lhote, Francois
    Ulrich, Marc
    Rumpler, Anne Charvet
    de Witte, Sten
    Krummel, Thierry
    Veyradier, Agnes
    Benhamou, Ygal
    [J]. BLOOD, 2021, 137 (06) : 733 - 742
  • [7] Predictive Features of Severe Acquired ADAMTS13 Deficiency in Idiopathic Thrombotic Microangiopathies: The French TMA Reference Center Experience
    Coppo, Paul
    Schwarzinger, Michael
    Buffet, Marc
    Wynckel, Alain
    Clabault, Karine
    Presne, Claire
    Poullin, Pascale
    Malot, Sandrine
    Vanhille, Philippe
    Azoulay, Elie
    Galicier, Lionel
    Lemiale, Virginie
    Mira, Jean-Paul
    Ridel, Christophe
    Rondeau, Eric
    Pourrat, Jacques
    Girault, Stephane
    Bordessoule, Dominique
    Saheb, Samir
    Ramakers, Michel
    Hamidou, Mohamed
    Vernant, Jean-Paul
    Guidet, Bertrand
    Wolf, Martine
    Veyradier, Agnes
    [J]. PLOS ONE, 2010, 5 (04):
  • [8] Neurological manifestations in thrombotic microangiopathy: Imaging features, risk factors and clinical course
    de Castro, Jose Thiago de Souza
    Appenzeller, Simone
    Colella, Marina Pereira
    Yamaguti-Hayakawa, Gabriela
    De Paula, Erich Vinicius
    Annichinno-Bizzachi, Joyce
    Cendes, Fernando
    Fabiano, Reis
    Orsi, Fernanda Andrade
    [J]. PLOS ONE, 2022, 17 (09):
  • [9] Mechanisms of ADAMTS13 regulation
    DeYoung, Veronica
    Singh, Kanwal
    Kretz, Colin A.
    [J]. JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2022, 20 (12) : 2722 - 2732
  • [10] Anticomplement Treatment in Atypical and Typical Hemolytic Uremic Syndrome
    Fakhouri, Fadi
    Loirat, Chantal
    [J]. SEMINARS IN HEMATOLOGY, 2018, 55 (03) : 150 - 158