Prognosis and risk factors of chronicity in childhood idiopathic thrombocytopenic purpura: a single-center experience

Objective: In previous studies, chronicity risk factors for idiopathic thrombocytopenic purpura (ITP) are unclear. This study aimed to evaluate the outcome of children with ITP and determine the chronicity risk factors. Methods: This study retrospectively examined the demographics, laboratories, outcome, and chronicity risk factors among sixty children with ITP and obtained the data from the computer system. We analyzed demographics, treatment, and laboratory risk factors for chronic ITP by IBM SPSS and used binary logistic regression analysis. Results: Of 60 children with ITP, 32 (53.3%) had acute, 25 (41.7%) had chronic, and 3 (5%) had persistent ITP. Demographics, laboratories (age <4 years, thrombocyte count at diagnosis, serum LDH, neutrophil count, mean platelet volume, status and grade of bleeding, infection in the last month) were unrelated to chronic ITP. As a new finding, loss of treatment response rates predicts chronicity in both univariate OR [2.56 (1.25 – 5.25)](p=0.01) and multivariate analysis OR [3.873 (1.488–10.08](p=0.006). Among second-line therapies, eltrombopag (n=6) achieved a durable response of thrombocyte count for more than 50.000/mm³ in five. However, two required the cessation of treatment two due to renal failure. Of two splenectomized patients, one could not achieve remission. Conclusion: Lower platelet counts (<20.000/mm³), younger age, male gender, and initial treatment regimens (IVIG, steroid, IVIG plus steroid) did not influence chronicity in our study. We suggest that loss of response rates predicts chronicity as a new factor.

Keywords:

Idiopathic Thrombocytopenic Purpura Chronic, Children,

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