Characteristics and outcomes of COVID-19 in Chinese immune thrombocytopenia patients: A prospective cohort study
Yunfei Chen1,2, Jiaying Liu1,2, Shuai Shao1,2
1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China.
Insights
COVID-19 infection in patients with immune thrombocytopenia (ITP) can lead to decreased platelet counts and pneumonia. Risk factors include low baseline platelets, TPO-RA therapy, and splenectomy for platelet drops, and older age, comorbidities, TPO-RA therapy, and immunosuppressants for pneumonia.
Area of Science:
- Hematology
- Infectious Diseases
- Immunology
Background:
- The COVID-19 pandemic significantly impacts the immune system.
- Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet counts.
- Understanding COVID-19's effects on ITP patients is crucial for managing this vulnerable population.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of pre-existing immune thrombocytopenia (ITP) patients infected with COVID-19 in China.
- To identify risk factors associated with decreased platelet counts and pneumonia development in ITP patients post-COVID-19 infection.
Main Methods:
- A prospective cohort study involving 1,148 pre-existing ITP patients infected with COVID-19.
- Data collection included baseline characteristics, COVID-19 infection details, and follow-up for at least one month.
- Statistical analysis was performed to identify risk factors for adverse outcomes.
Main Results:
- 18.5% of ITP patients experienced a decrease in platelet (PLT) count after COVID-19 infection.
- 4.1% of patients were diagnosed with pneumonia.
- Risk factors for decreased PLT count included lower baseline PLT count, TPO-RA therapy, and prior splenectomy.
- Risk factors for pneumonia included older age, multiple comorbidities, TPO-RA therapy, and immunosuppressant use.
Conclusions:
- Pre-existing ITP patients infected with COVID-19 face risks of platelet count reduction and pneumonia.
- Baseline platelet count, TPO-RA therapy, and splenectomy are associated with decreased platelet counts.
- Age, comorbidities, TPO-RA therapy, and immunosuppressants are risk factors for pneumonia in this cohort.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic has a significant impact on the immune system. This is the first and largest study on pre-existing immune thrombocytopenia (ITP) patients infected with COVID-19 in China. We prospectively collected ITP patients infected with COVID-19 enrolled in the National Longitudinal Cohort of Hematological Diseases (NICHE, NCT04645199) and followed up for at least 1 month after infection. One thousand and one hundred forty-eight pre-existing ITP patients were included. Two hundred and twelve (18.5%) patients showed a decrease in the platelet (PLT) count after infection. Forty-seven (4.1%) patients were diagnosed with pneumonia. Risk factors for a decrease in the PLT count included baseline PLT count <50 × 109/L (OR, 1.76; 95% CI, 1.25-2.46; p = 0.001), maintenance therapy including thrombopoietin receptor agonists (TPO-RAs) (OR, 2.27; 95% CI, 1.60-3.21; p < 0.001) and previous splenectomy (OR, 1.98; 95% CI, 1.09-3.61; p = 0.03). Risk factors for pneumonia included age ≥40 years (OR, 2.45; 95% CI, 1.12-5.33; p = 0.02), ≥2 comorbidities (OR, 3.47; 95% CI, 1.63-7.64; p = 0.001), maintenance therapy including TPO-RAs (OR, 2.14; 95% CI, 1.17-3.91; p = 0.01) and immunosuppressants (OR, 3.05; 95% CI, 1.17-7.91; p = 0.02). In this cohort study, we described the characteristics of pre-existing ITP patients infected with COVID-19 and identified several factors associated with poor outcomes.
