All-Cause and Exacerbation-Related Readmissions in Thrombotic Microangiopathy Requiring Plasmapheresis: A Population-Based Cohort Study.

OBJECTIVE

Thrombotic microangiopathy (TMA) is a serious condition characterized by microangiopathic hemolytic anemia and thrombocytopenia, with high exacerbation rates. This study examined all-cause and exacerbation-related readmission risks among patients hospitalized with TMA requiring plasmapheresis.

MATERIALS AND

METHODS

Secondary analysis of the 2020 Nationwide Readmission Database was conducted, including discharge data from non-federal hospitals in 31 U.S. states. Patients aged 18 years or older admitted non-electively with a primary or secondary diagnosis of TMA requiring plasmapheresis were included. Exacerbation-related readmission was defined as subsequent admission requiring plasmapheresis within 7 or 30 days after the original discharge. Multivariable logistic regression and Cox proportional hazards models were used to assess readmission risks, adjusting for demographics, comorbidities, and predisposing factors.

RESULTS

Among an estimated 1393 patients, 791 (56.8%) had predisposing conditions. All-cause readmissions were more frequent in patients with predisposing conditions (26.2% vs. 21.9%), while exacerbation-related readmissions were more common in TMA-only patients (9.0% vs. 3.4% at 7 days; 13.7% vs. 6.4% at 30 days). Most exacerbations occurred within 14 days after discharge. No patients treated with caplacizumab experienced exacerbation. TMA-only patients had a 2.1-times higher risk of 30-day exacerbation-related readmissions (adjusted hazard ratio: 2.10, p=0.04). Rural residence and patient-directed discharge were potential risk factors for exacerbation-related readmissions.

CONCLUSIONS

These findings highlight the need for improved post-discharge care and treatment strategies to prevent readmissions. Further studies should explore interventions to reduce exacerbation-related readmissions, particularly in high-risk populations.