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

Abstract

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.