Analysis of causes and outcomes of principal secondary thrombotic microangiopathy: a 9-year cohort study from a tertiary pediatric center in China.

Authors

Dan Wu, Jie Zheng, Jun Yang, Bin Wang, Guanghua Zhu, Zhi Chen, Qiang Sun, Nan Zhou, Zhenping Chen, Yanhui Luo, Wei Yang, Xiaoyu Tian, Hejia Zhang, Xue Liu, Lei Lei, Na Tian, Kaige Zhang, Li Fang, Lan Mi, Ang Wei, Ying Liang, Maoquan Qin, Xiaorong Liu, Chenguang Jia

Published in

Research and practice in thrombosis and haemostasis. Volume 10. Issue 5. Pages 106850. Epub Jul 14, 2026.

Abstract

Few large-scale cohort studies have reviewed consecutive cases of thrombotic microangiopathy (TMA), especially in children.
The aim of our study was to evaluate causes and outcomes of TMA at a tertiary pediatric center in China over a 9-year period.
We retrospectively analyzed consecutive pediatric TMA patients admitted to Beijing Children's Hospital from December 2015 to January 2025. The primary endpoint was death or progression to kidney failure. Multivariable Cox regression identified independent predictors of this composite endpoint.
We retrospectively analyzed 303 consecutive pediatric patients with a first episode of TMA. Secondary TMA was the most common type (n = 172; 57%), followed by atypical hemolytic uremic syndrome (n = 93; 31%), thrombotic thrombocytopenic purpura (n = 24; 8%), and Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (n = 14; 5%). Among the 172 cases of secondary TMA, the most common causes were hematopoietic stem cell transplantation (n = 95; 55%) and systemic diseases (n = 40; 23%). After a median follow-up of 35 months, death or kidney failure occurred in 53 (31%), 7 (8%), 1 (4%), and 0 patients with secondary TMA, atypical hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome, respectively. Multivariate Cox regression showed that secondary TMA (hazard ratio [HR], 3.57; 95% CI, 1.53-8.30; P < .01), the presence of heart failure and/or shock at onset (HR, 2.21; 95% CI, 1.24-3.93; P = .01), and the need for mechanical ventilation support due to respiratory failure (HR, 3.88; 95% CI, 2.19-6.88; P < .001) were independent risk factors for death or kidney failure.
This study shows that secondary TMA is the predominant form of pediatric TMA. Secondary TMA, heart failure/shock, and the requirement for mechanical ventilation were identified as independent risk factors for death or kidney failure in children.

PMID:
42572553
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.

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