Original article

Vol. 22 No. 5 (2024): Blood Transfusion 5-2024 (September-October)

Bleeding recurrence risk among hospitalized patients undergoing therapeutic plasma exchange: a multi-center study

Authors

Key words: plasmapheresis, hemorrhage, blood transfusion, hemostasis, transfusion medicine
Publication Date: 2024-07-19

Abstract

Background - In hospitalized patients undergoing therapeutic plasma exchange (TPE), it is not known how TPE-associated bleeding risk is impacted by a prior bleeding episode. Therefore, to assess the prevalence and predictors of bleeding recurrence, we analyzed data from the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III).

Materials and methods - Using a retrospective cross-sectional analysis of REDS-III public use files, we identified hospitalized adults who had a major bleeding episode prior to their first TPE procedure. Patients were classified into two cohorts based on bleeding recurrence (no-recurrence vs recurrence). After identifying potential predictors, we used multiple imputation by chained equations to impute variables with <30% missing data. Variable selection was optimized using a 10-fold cross validated least absolute shrinkage and selection operator. Final predictors were identified by fitting a logistic regression model.

Results - In 310 patients with major bleeding prior to TPE initiation, bleeding recurred in 121 (39.0%). We identified the following seven unique predictors: 1) >10 TPE procedures (OR 2.23); 2) intensive care unit stay (OR 1.35); 3) thrombocytopenia (OR 1.26); 4) surgery (OR 1.22); 5) hepatic disease (OR 1.21); 6) 6-10 TPE procedures (OR 1.04); and 7) Asian race (OR 1.01). We also identified the following five interactions: 1) surgery and therapeutic anticoagulation (OR 1.50); 2) 6-10 TPE procedures and therapeutic anticoagulation (OR 1.05); 3) 6-10 TPE procedures and antiplatelets (OR 1.02); 4) >10 TPE procedures and antiplatelets (OR 1.00); and 5) albumin-only TPE and antiplatelets (OR 0.53). When assessed for adjusted performance, the prediction model had a C-statistic of 0.617 (95% CI 0.613-0.619) and Brier Score of 0.342 (95% CI 0.340-0.347).

Discussion - In this study assessing predictors of bleeding recurrence among hospitalized patients undergoing TPE, we identified seven variables and five interactions. These findings should be validated in future studies.

Authors

Alexandre Soares Ferreira Junior - Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil

Morgana Pinheiro Maux Lessa - Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil

Kate Sanborn - Duke Biostatistics, Epidemiology and Research Design Core, Duke University School of Medicine, Durham, NC, United States of America

Alexander Gordee - Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States of America

Maragatha Kuchibhatla - Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States of America

Matthew S Karafin - Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, United States of America

Oluwatoyosi A. Onwuemene - Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America

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