Bleeding outcomes of inpatients receiving therapeutic plasma exchange: A propensity‐matched analysis of the National Inpatient Sample
Background Although therapeutic plasma exchange (TPE) is associated with hemostatic abnormalities, its impact on bleeding outcomes is unknown. Therefore, the main study objective was to determine bleeding outcomes of inpatients treated with TPE. Study Design and Methods In a cross‐sectional analysis...
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| Veröffentlicht in: | Transfusion (Philadelphia, Pa.) Pa.), 2022-02, Vol.62 (2), p.386-395 |
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| creator | Soares Ferreira Júnior, Alexandre Boyle, Stephen H. Kuchibhatla, Maragatha Onwuemene, Oluwatoyosi A. |
| description | Background
Although therapeutic plasma exchange (TPE) is associated with hemostatic abnormalities, its impact on bleeding outcomes is unknown. Therefore, the main study objective was to determine bleeding outcomes of inpatients treated with TPE.
Study Design and Methods
In a cross‐sectional analysis of the National Inpatient Sample (NIS), discharges were identified with 10 common TPE‐treated conditions. A 1:3 propensity‐matched analysis of TPE‐ to non‐TPE‐treated discharges was performed. The primary outcome was major bleeding and secondary outcomes were packed red blood cell (PRBC) transfusion, mortality, disposition, hospital length of stay (LOS), and charges. Multivariable regression analyses were used to examine the association between TPE and study outcomes.
Results
The study population was 15,964 discharges, of which 3991 were TPE‐ treated. The prevalence of major bleeding was low (5.4%). When compared to non‐TPE discharges, TPE had a significant and positive association with major bleeding (OR = 1.37, 95% CI: 1.16–1.63, p = .0003). TPE was also associated with PRBC transfusion (OR = 1.66, 95% CI: 1.42–1.94, p |
| doi_str_mv | 10.1111/trf.16769 |
| format | Article |
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Although therapeutic plasma exchange (TPE) is associated with hemostatic abnormalities, its impact on bleeding outcomes is unknown. Therefore, the main study objective was to determine bleeding outcomes of inpatients treated with TPE.
Study Design and Methods
In a cross‐sectional analysis of the National Inpatient Sample (NIS), discharges were identified with 10 common TPE‐treated conditions. A 1:3 propensity‐matched analysis of TPE‐ to non‐TPE‐treated discharges was performed. The primary outcome was major bleeding and secondary outcomes were packed red blood cell (PRBC) transfusion, mortality, disposition, hospital length of stay (LOS), and charges. Multivariable regression analyses were used to examine the association between TPE and study outcomes.
Results
The study population was 15,964 discharges, of which 3991 were TPE‐ treated. The prevalence of major bleeding was low (5.4%). When compared to non‐TPE discharges, TPE had a significant and positive association with major bleeding (OR = 1.37, 95% CI: 1.16–1.63, p = .0003). TPE was also associated with PRBC transfusion (OR = 1.66, 95% CI: 1.42–1.94, p < .0001), in‐hospital mortality (OR = 1.45, 95% CI: 1.10–1.90, p = .0008), hospital length of stay (12.45 [95% CI: 11.95–12.97] vs. 7.38 [95% CI: 7.12–7.65] days, p < .0001) and total charges, ($125,123 [95% CI: $119,220–$131,317] vs. $61,953 [95% CI: $59,391–$64,625], p < .0001), and disposition to non‐self‐care (OR = 1.29, 95% CI: 1.19–1.39, p < .0001).
Discussion
The use of TPE in the inpatient setting is positively associated with bleeding; however, with low prevalence. Future studies should address risk factors that predispose patients to TPE‐associated bleeding.</description><identifier>ISSN: 0041-1132</identifier><identifier>EISSN: 1537-2995</identifier><identifier>DOI: 10.1111/trf.16769</identifier><identifier>PMID: 34907537</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Abnormalities ; Apheresis ; Bleeding ; Blood transfusion ; Cross-Sectional Studies ; Erythrocytes ; Hemorrhage - epidemiology ; Hemorrhage - etiology ; Hemorrhage - therapy ; Hospital Mortality ; Humans ; Inpatients ; Length of Stay ; Mortality ; National Inpatient Sample ; Plasma Exchange - adverse effects ; plasmapheresis ; Population studies ; Regression analysis ; Retrospective Studies ; Risk analysis ; Risk factors ; Transfusion</subject><ispartof>Transfusion (Philadelphia, Pa.), 2022-02, Vol.62 (2), p.386-395</ispartof><rights>2021 AABB.</rights><rights>2022 AABB</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-f115e4b9fb1d6e946ead776201632da01c2e990aa79be0e8b6c70f0e54d6486d3</citedby><cites>FETCH-LOGICAL-c3539-f115e4b9fb1d6e946ead776201632da01c2e990aa79be0e8b6c70f0e54d6486d3</cites><orcidid>0000-0001-7266-7101</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftrf.16769$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftrf.16769$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34907537$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Soares Ferreira Júnior, Alexandre</creatorcontrib><creatorcontrib>Boyle, Stephen H.</creatorcontrib><creatorcontrib>Kuchibhatla, Maragatha</creatorcontrib><creatorcontrib>Onwuemene, Oluwatoyosi A.</creatorcontrib><title>Bleeding outcomes of inpatients receiving therapeutic plasma exchange: A propensity‐matched analysis of the National Inpatient Sample</title><title>Transfusion (Philadelphia, Pa.)</title><addtitle>Transfusion</addtitle><description>Background
Although therapeutic plasma exchange (TPE) is associated with hemostatic abnormalities, its impact on bleeding outcomes is unknown. Therefore, the main study objective was to determine bleeding outcomes of inpatients treated with TPE.
Study Design and Methods
In a cross‐sectional analysis of the National Inpatient Sample (NIS), discharges were identified with 10 common TPE‐treated conditions. A 1:3 propensity‐matched analysis of TPE‐ to non‐TPE‐treated discharges was performed. The primary outcome was major bleeding and secondary outcomes were packed red blood cell (PRBC) transfusion, mortality, disposition, hospital length of stay (LOS), and charges. Multivariable regression analyses were used to examine the association between TPE and study outcomes.
Results
The study population was 15,964 discharges, of which 3991 were TPE‐ treated. The prevalence of major bleeding was low (5.4%). When compared to non‐TPE discharges, TPE had a significant and positive association with major bleeding (OR = 1.37, 95% CI: 1.16–1.63, p = .0003). TPE was also associated with PRBC transfusion (OR = 1.66, 95% CI: 1.42–1.94, p < .0001), in‐hospital mortality (OR = 1.45, 95% CI: 1.10–1.90, p = .0008), hospital length of stay (12.45 [95% CI: 11.95–12.97] vs. 7.38 [95% CI: 7.12–7.65] days, p < .0001) and total charges, ($125,123 [95% CI: $119,220–$131,317] vs. $61,953 [95% CI: $59,391–$64,625], p < .0001), and disposition to non‐self‐care (OR = 1.29, 95% CI: 1.19–1.39, p < .0001).
Discussion
The use of TPE in the inpatient setting is positively associated with bleeding; however, with low prevalence. Future studies should address risk factors that predispose patients to TPE‐associated bleeding.</description><subject>Abnormalities</subject><subject>Apheresis</subject><subject>Bleeding</subject><subject>Blood transfusion</subject><subject>Cross-Sectional Studies</subject><subject>Erythrocytes</subject><subject>Hemorrhage - epidemiology</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - therapy</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Inpatients</subject><subject>Length of Stay</subject><subject>Mortality</subject><subject>National Inpatient Sample</subject><subject>Plasma Exchange - adverse effects</subject><subject>plasmapheresis</subject><subject>Population studies</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Transfusion</subject><issn>0041-1132</issn><issn>1537-2995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10ctKxDAUBuAgio6XhS8gATe6qOakbWrcqXgDUfCyLml66kR6M0nV2blz6zP6JGYcdSGYTSB8-XPIT8g6sB0Ia9fbagdEJuQcGUEaZxGXMp0nI8YSiABivkSWnXtgjHHJYJEsxYlkWYAj8nZYI5amvafd4HXXoKNdRU3bK2-w9Y5a1GiepsCP0aoeB2807WvlGkXxRY9Ve4_79ID2tuuxdcZPPl7fG-X1GEuqWlVPnPkKDffpZYjtwhk9_3mB3qimr3GVLFSqdrj2va-Qu5Pj26Oz6OLq9Pzo4CLScRrLqAJIMSlkVUApUCYCVZllgjMQMS8VA81RSqZUJgtkuFcInbGKYZqUItkTZbxCtma5YdzHAZ3PG-M01rVqsRtczgWET4OUQ6Cbf-hDN9gw_FTxLGYcEh7U9kxp2zlnscp7axplJzmwfNpOHtrJv9oJduM7cSgaLH_lTx0B7M7As6lx8n9Sfnt9Mov8BLB6nCo</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Soares Ferreira Júnior, Alexandre</creator><creator>Boyle, Stephen H.</creator><creator>Kuchibhatla, Maragatha</creator><creator>Onwuemene, Oluwatoyosi A.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7266-7101</orcidid></search><sort><creationdate>202202</creationdate><title>Bleeding outcomes of inpatients receiving therapeutic plasma exchange: A propensity‐matched analysis of the National Inpatient Sample</title><author>Soares Ferreira Júnior, Alexandre ; Boyle, Stephen H. ; Kuchibhatla, Maragatha ; Onwuemene, Oluwatoyosi A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-f115e4b9fb1d6e946ead776201632da01c2e990aa79be0e8b6c70f0e54d6486d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abnormalities</topic><topic>Apheresis</topic><topic>Bleeding</topic><topic>Blood transfusion</topic><topic>Cross-Sectional Studies</topic><topic>Erythrocytes</topic><topic>Hemorrhage - epidemiology</topic><topic>Hemorrhage - etiology</topic><topic>Hemorrhage - therapy</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Inpatients</topic><topic>Length of Stay</topic><topic>Mortality</topic><topic>National Inpatient Sample</topic><topic>Plasma Exchange - adverse effects</topic><topic>plasmapheresis</topic><topic>Population studies</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Transfusion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soares Ferreira Júnior, Alexandre</creatorcontrib><creatorcontrib>Boyle, Stephen H.</creatorcontrib><creatorcontrib>Kuchibhatla, Maragatha</creatorcontrib><creatorcontrib>Onwuemene, Oluwatoyosi A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transfusion (Philadelphia, Pa.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soares Ferreira Júnior, Alexandre</au><au>Boyle, Stephen H.</au><au>Kuchibhatla, Maragatha</au><au>Onwuemene, Oluwatoyosi A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bleeding outcomes of inpatients receiving therapeutic plasma exchange: A propensity‐matched analysis of the National Inpatient Sample</atitle><jtitle>Transfusion (Philadelphia, Pa.)</jtitle><addtitle>Transfusion</addtitle><date>2022-02</date><risdate>2022</risdate><volume>62</volume><issue>2</issue><spage>386</spage><epage>395</epage><pages>386-395</pages><issn>0041-1132</issn><eissn>1537-2995</eissn><abstract>Background
Although therapeutic plasma exchange (TPE) is associated with hemostatic abnormalities, its impact on bleeding outcomes is unknown. Therefore, the main study objective was to determine bleeding outcomes of inpatients treated with TPE.
Study Design and Methods
In a cross‐sectional analysis of the National Inpatient Sample (NIS), discharges were identified with 10 common TPE‐treated conditions. A 1:3 propensity‐matched analysis of TPE‐ to non‐TPE‐treated discharges was performed. The primary outcome was major bleeding and secondary outcomes were packed red blood cell (PRBC) transfusion, mortality, disposition, hospital length of stay (LOS), and charges. Multivariable regression analyses were used to examine the association between TPE and study outcomes.
Results
The study population was 15,964 discharges, of which 3991 were TPE‐ treated. The prevalence of major bleeding was low (5.4%). When compared to non‐TPE discharges, TPE had a significant and positive association with major bleeding (OR = 1.37, 95% CI: 1.16–1.63, p = .0003). TPE was also associated with PRBC transfusion (OR = 1.66, 95% CI: 1.42–1.94, p < .0001), in‐hospital mortality (OR = 1.45, 95% CI: 1.10–1.90, p = .0008), hospital length of stay (12.45 [95% CI: 11.95–12.97] vs. 7.38 [95% CI: 7.12–7.65] days, p < .0001) and total charges, ($125,123 [95% CI: $119,220–$131,317] vs. $61,953 [95% CI: $59,391–$64,625], p < .0001), and disposition to non‐self‐care (OR = 1.29, 95% CI: 1.19–1.39, p < .0001).
Discussion
The use of TPE in the inpatient setting is positively associated with bleeding; however, with low prevalence. Future studies should address risk factors that predispose patients to TPE‐associated bleeding.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>34907537</pmid><doi>10.1111/trf.16769</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-7266-7101</orcidid></addata></record> |
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| ispartof | Transfusion (Philadelphia, Pa.), 2022-02, Vol.62 (2), p.386-395 |
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| source | MEDLINE; Wiley Journals |
| subjects | Abnormalities Apheresis Bleeding Blood transfusion Cross-Sectional Studies Erythrocytes Hemorrhage - epidemiology Hemorrhage - etiology Hemorrhage - therapy Hospital Mortality Humans Inpatients Length of Stay Mortality National Inpatient Sample Plasma Exchange - adverse effects plasmapheresis Population studies Regression analysis Retrospective Studies Risk analysis Risk factors Transfusion |
| title | Bleeding outcomes of inpatients receiving therapeutic plasma exchange: A propensity‐matched analysis of the National Inpatient Sample |
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