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Open AccessArticle

Usefulness of the Thrombotic Microangiopathy Score as a Promising Prognostic Marker of Septic Shock for Patients in the Emergency Department

1
Department of Emergency Medicine, Yonsei University College of Medicine, 06273 Seoul, Korea
2
Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, 24289 Chuncheon, Korea
3
Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, 06273 Seoul, Korea
4
Department of Laboratory Medicine, Konyang University Hospital, 35365 Daejon, Korea
5
Department of Emergency Medicine, Good Sunlin Hospital, 37725 Pohang, Korea
6
Department of Emergency Medicine, Graduate School of medicine, Kosin University, 49267 Busan, Korea
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Those authors contributed equally to this work.
J. Clin. Med. 2019, 8(6), 808; https://doi.org/10.3390/jcm8060808
Received: 3 May 2019 / Revised: 3 June 2019 / Accepted: 4 June 2019 / Published: 6 June 2019
The thrombotic microangiopathy (TMA) score based on the development and morphological characteristics of schistocytes is a rapid, simple biomarker that is easily obtained from the complete blood cell count by an automated blood cell analyzer. We aimed to determine whether the TMA score is associated with 30-day mortality of patients with early-stage septic shock. This observational cohort study was retrospectively conducted based on a prospective emergency department (ED) registry (June 2015–December 2016). We analyzed the TMA score at ED admission and 24 h later. The primary endpoint was all-cause mortality within 30 days of ED admission. A total of 221 patients were included. Increased TMA scores at time 0 (odds ratio (OR), 1.972; 95% confidence interval (CI), 1.253–3.106; p = 0.003) and at time 24 (OR, 1.863; 95% CI, 1.863–3.066; p = 0.014) were strong predictors of 30-day mortality. Increased predictability of 30-day mortality was closely associated with TMA scores ≥2 at time 0 (OR, 4.035; 95% CI, 1.651–9.863; p = 0.002) and ≥3 at time 24 (OR, 5.639; 95% CI, 2.190–14.519; p < 0.001). Increased TMA scores significantly predicted 30-day mortality for patients with severe sepsis and septic shock and can be helpful when determining the initial treatment strategies without additional costs or effort. View Full-Text
Keywords: sepsis; thrombotic microangiopathy score; mortality; predictor sepsis; thrombotic microangiopathy score; mortality; predictor
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    Doi: 10.5281/zenodo.3234237
    Description: Table S1: Univariate logistic regression analysis of predictors of 30-day mortality, Table S2: Comparing scoring systems and biomarkers for the prediction of 30-day mortality using the area under the curve, Table S3: Comparison of the performance of the prediction of 30-day mortality with and without the TMA score by area under the receiver operating characteristic curve. Figure S4: The TMA score as a predictor of 7-day mortality. Higher TMA score at admission (A) and 24 h (B) after admission were significantly associated with an increased risk of 7-day mortality among patients with septic shock.
MDPI and ACS Style

Ko, D.R.; Kong, T.; Lee, H.S.; Kim, S.; Lee, J.W.; Chung, H.S.; Chung, S.P.; You, J.S.; Park, J.W. Usefulness of the Thrombotic Microangiopathy Score as a Promising Prognostic Marker of Septic Shock for Patients in the Emergency Department. J. Clin. Med. 2019, 8, 808.

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