PB0314 - Treatment Delay and outcomes in Elderly TTP Patients: A Nationwide Analysis

Background: Significant gaps appear to exist in the management of TTP in the elderly population, with atypical clinical and laboratory features and co-morbidities that may delay diagnosis.

Aims: To examine the effect of age on treatment delay and other outcomes in hospitalized TTP patients.

Methods: We analyzed the National Inpatient Sample database (2012-2019), and identified all patients aged ≥18 years with a diagnosis of TTP who underwent therapeutic plasma exchange (TPE) during hospital stay. Age was subclassified into 3 groups (18-39, 40-59, and ≥ 60) and time from hospitalization to initiation of TPE and other adverse hospitalization outcomes were compared between groups. Multivariable logistic regression was performed for each outcome, adjusting for socio-demographic, hospital, and comorbid characteristics.

Results: We identified 999, 1142, and 851 TTP patients in the 18-39, 40-59, and ≥ 60 age groups, respectively. Compared to the younger age groups, older age groups were more likely to be male, white race, and had a higher median household income and co-morbidities. On unadjusted analysis, a ≥ 2 days delay in initiation of TPE was more prevalent in the older age groups (31.9% vs 34.4% vs 47.6%, P< 0.001). After adjusting for socio-demographic and comorbid characteristics, the ≥ 60 age group had 1.65-fold-odds of having a delay of ≥ 2 days in initiation of TPE (adjusted odds ratio 1.649; 95% CI, 1.321-2.058, P< 0.001), compared to the 18-39 age group (table 1). The ≥ 60 age group was also associated with higher mortality, longer length of stay, and higher prevalence of venous and arterial thrombo-embolism, major bleeding, and mechanical ventilation, when compared to the 18-39 age group. A ≥ 2 days delay form admission to starting TPE was independently associated with higher in-hospital mortality (figure 1).

Conclusion(s): Older age is independently associated with delay in management and adverse outcomes in TTP patients.