Trends, predictors and outcomes of cerebrovascular disease amongst patients with thrombotic microangiopathy

Background: Thrombotic Microangiopathy (TMA) is a rare disorder affecting the coagulation system causing microangiopathic thrombus formation within various blood vessels including the cerebral arteries It may be seen in association with thrombocytopenia, anemia, purpura and kidney failure as well as complications of various systemic viral illnesses We sought to estimate the trends, predictors, and outcomes of CeVD in patients having ™ from a nationally representative database of the USA Methods: In this cross-sectional study, we identified hospitalization with TM using ICD-9/10-CM from the National Inpatient Sample (NIS) for the years 2008-2017 Prevalence of CeVD was identified by validated ICD-9/10-CM codes We utilized Cochran Armitage trend test and multivariable survey logistic regression models to analyze temporal trends, outcomes and predictors of any CeVD in TM patients Results: Out of a total 58,850 hospitalizations among TMA patients, 4,668 (7 9%) developed CeVD Prevalence of CeVD increased from 6 2% in 2008 to 8 2% in 2017 (pTrend<0 001) Patients who developed CeVD were older and more likely to be female In multivariable regression analysis, increasing age (OR 1 2;95%CI 1 1-1 2;p<0 0001);females (OR 1 3;95%CI 1 1-1 6;p<0 0004);African American (OR 1 4;95%CI 1 2-1 7;p<0 001) and hypertension (OR 1 3;95%CI 1 1-1 6;p<0 0001) CeVD was also associated with higher length of stay (18 vs 12 days;p<0 001) Additionally, CeVD was associated with higher in-hospital mortality (aOR 2 1;95%CI 1 7-2 5;p<0 001) and discharge to facility (aOR 3 0;95%CI 2 4-3 5;p<0 001) after adjusting with confounders Conclusion: We observed the mildly incremental prevalence of CeVD among TMA patients We were able to identify the TMA patient population susceptible to CeVD, most commonly occurring in older, females and African Americans CeVD was also associated with significantly poor outcomes in TM These findings may pose similarities to other systemic viral illness-induced thrombotic microangiopathy such as COVID-19 Further studies are required to improve the outcomes of these susceptible patient populations