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Impact of a multidisciplinary team for the management of thrombotic microangiopathy
BACKGROUND: Thrombotic microangiopathy (TMA) is an important complication associated with several diseases that are rare and life-threatening. TMA is common to thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). TTP is defined by a severe deficiency of ADAMTS13, and early...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214549/ https://www.ncbi.nlm.nih.gov/pubmed/30388144 http://dx.doi.org/10.1371/journal.pone.0206558 |
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author | Uriol Rivera, Miguel G. Cabello Pelegrin, Sheila Ballester Ruiz, Carmen López Andrade, Bernardo Lumbreras, Javier Obrador Mulet, Aina Perez Montaña, Albert Ferreruela Serlavos, Mireia Ayestarán Rota, José Ignacio Ferrer Balaguer, Joana Delgado Sanchez, Olga Pallares Ferreres, Lucio Mas Bonet, Antonio Picado Valles, María Jose de Gopegui Valero, Rosa María Ruíz |
author_facet | Uriol Rivera, Miguel G. Cabello Pelegrin, Sheila Ballester Ruiz, Carmen López Andrade, Bernardo Lumbreras, Javier Obrador Mulet, Aina Perez Montaña, Albert Ferreruela Serlavos, Mireia Ayestarán Rota, José Ignacio Ferrer Balaguer, Joana Delgado Sanchez, Olga Pallares Ferreres, Lucio Mas Bonet, Antonio Picado Valles, María Jose de Gopegui Valero, Rosa María Ruíz |
author_sort | Uriol Rivera, Miguel G. |
collection | PubMed |
description | BACKGROUND: Thrombotic microangiopathy (TMA) is an important complication associated with several diseases that are rare and life-threatening. TMA is common to thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). TTP is defined by a severe deficiency of ADAMTS13, and early treatment is associated with good prognosis. The diagnosis of HUS can be difficult due to the potential multiple etiologies, and the best treatment option in most cases is not well-established yet. The implementation of a multidisciplinary team (MDT) could decrease the time to diagnosis and treatment for HUS and may improve the outcomes of these patients. OBJECTIVE: To determine the impact of MDT on morbidity and mortality [death or chronic renal replacement therapy (CRRT) requirements], incidence and response time [(RT) defined as the period between hospital admission and the first day of direct therapy administration], length of stay at an intensive care unit (ICU-LOS) and total hospitalization (T-LOS) were also assessed. METHODS: We compared a pre-MDT implementation period (from January/2008 to May/2016) versus post-MDT period (from May/2016 to December/2016). The screening TMA diagnosis was made according the following criteria: hemolytic anemia, thrombocytopenia and acute renal damage and without ADAMTS13 deficiency. An online chat was implemented to provide instant medical information. RESULTS: Twenty-eight patients were included. The incidence changed from 2.3 cases/pre-MDT: (all cases: n = 18) to 10 cases/year post-MDT (all cases: n = 10). Two patients died in pre-MDT and post- MDT (11% versus 20%, P = 0.60). From pre-MDT, the number of patients who required CRRT by post-MDT decreased from 7 (39%) to 0, P = 0.03. Similarly, RT, ICU-LOS and T-LOS [median(p25-p75)] decreased from 10 (2–12) days to 0.5 (0–1.5) days, P = 0.04, from 16 (9–30) days to 10 (4–13) days, P = 0.01 and from 33 (22–53) days to 16 (12–32) days, P < 0.01, respectively. CONCLUSION: MDT implementation was associated with a greater number of patients who meet TMA criteria. A decrease in the RT and T-LOS periods were observed and associated with better outcomes in these patients. |
format | Online Article Text |
id | pubmed-6214549 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-62145492018-11-19 Impact of a multidisciplinary team for the management of thrombotic microangiopathy Uriol Rivera, Miguel G. Cabello Pelegrin, Sheila Ballester Ruiz, Carmen López Andrade, Bernardo Lumbreras, Javier Obrador Mulet, Aina Perez Montaña, Albert Ferreruela Serlavos, Mireia Ayestarán Rota, José Ignacio Ferrer Balaguer, Joana Delgado Sanchez, Olga Pallares Ferreres, Lucio Mas Bonet, Antonio Picado Valles, María Jose de Gopegui Valero, Rosa María Ruíz PLoS One Research Article BACKGROUND: Thrombotic microangiopathy (TMA) is an important complication associated with several diseases that are rare and life-threatening. TMA is common to thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). TTP is defined by a severe deficiency of ADAMTS13, and early treatment is associated with good prognosis. The diagnosis of HUS can be difficult due to the potential multiple etiologies, and the best treatment option in most cases is not well-established yet. The implementation of a multidisciplinary team (MDT) could decrease the time to diagnosis and treatment for HUS and may improve the outcomes of these patients. OBJECTIVE: To determine the impact of MDT on morbidity and mortality [death or chronic renal replacement therapy (CRRT) requirements], incidence and response time [(RT) defined as the period between hospital admission and the first day of direct therapy administration], length of stay at an intensive care unit (ICU-LOS) and total hospitalization (T-LOS) were also assessed. METHODS: We compared a pre-MDT implementation period (from January/2008 to May/2016) versus post-MDT period (from May/2016 to December/2016). The screening TMA diagnosis was made according the following criteria: hemolytic anemia, thrombocytopenia and acute renal damage and without ADAMTS13 deficiency. An online chat was implemented to provide instant medical information. RESULTS: Twenty-eight patients were included. The incidence changed from 2.3 cases/pre-MDT: (all cases: n = 18) to 10 cases/year post-MDT (all cases: n = 10). Two patients died in pre-MDT and post- MDT (11% versus 20%, P = 0.60). From pre-MDT, the number of patients who required CRRT by post-MDT decreased from 7 (39%) to 0, P = 0.03. Similarly, RT, ICU-LOS and T-LOS [median(p25-p75)] decreased from 10 (2–12) days to 0.5 (0–1.5) days, P = 0.04, from 16 (9–30) days to 10 (4–13) days, P = 0.01 and from 33 (22–53) days to 16 (12–32) days, P < 0.01, respectively. CONCLUSION: MDT implementation was associated with a greater number of patients who meet TMA criteria. A decrease in the RT and T-LOS periods were observed and associated with better outcomes in these patients. Public Library of Science 2018-11-02 /pmc/articles/PMC6214549/ /pubmed/30388144 http://dx.doi.org/10.1371/journal.pone.0206558 Text en © 2018 Uriol Rivera et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Uriol Rivera, Miguel G. Cabello Pelegrin, Sheila Ballester Ruiz, Carmen López Andrade, Bernardo Lumbreras, Javier Obrador Mulet, Aina Perez Montaña, Albert Ferreruela Serlavos, Mireia Ayestarán Rota, José Ignacio Ferrer Balaguer, Joana Delgado Sanchez, Olga Pallares Ferreres, Lucio Mas Bonet, Antonio Picado Valles, María Jose de Gopegui Valero, Rosa María Ruíz Impact of a multidisciplinary team for the management of thrombotic microangiopathy |
title | Impact of a multidisciplinary team for the management of thrombotic microangiopathy |
title_full | Impact of a multidisciplinary team for the management of thrombotic microangiopathy |
title_fullStr | Impact of a multidisciplinary team for the management of thrombotic microangiopathy |
title_full_unstemmed | Impact of a multidisciplinary team for the management of thrombotic microangiopathy |
title_short | Impact of a multidisciplinary team for the management of thrombotic microangiopathy |
title_sort | impact of a multidisciplinary team for the management of thrombotic microangiopathy |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214549/ https://www.ncbi.nlm.nih.gov/pubmed/30388144 http://dx.doi.org/10.1371/journal.pone.0206558 |
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