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Initial response and long-term prognostic risk factors in pediatric ITP
Li Zhang1, Jiebin Qin1, Lan Huang1
1Department of Hematology and Oncology of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents' Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, No.136 of Zhongshan 2 road, Yu Zhong district, Chongqing, 400014, China.
Objective:
To explore the clinical features and prognostic factors for initial response and long-term prognosis of pediatric immune thrombocytopenia (ITP).
Method:
A retrospective cohort study of 910 cases of pediatric patients with ITP was conducted. Demographic data, platelet counts, triggers, bleeding grades, glucocorticoid (GC) tapering time, IVIG status and treatment outcomes were collected. Initial response was defined as a platelet counts ≥ 30 × 109/L and at least doubling baseline at 1 month after first-line therapy. Logistic regression analysis and restricted cubic spline (RCS) analyses were performed to identify the risk factors for initial response and long-term prognosis.
Results:
GC tapering time (OR = 0.39, 95% CI:0.16-0.91, p = 0.03) and bleeding grade 5 (OR = 0.26, 95% CI:0.11-0.52, p < 0.001) were significantly associated with initial response. Age ≥ 3 years (OR = 1.83, 95% CI: 1.18-2.84, p = 0.007) was identified as an independent risk factor for long-term prognosis of pediatric ITP. RCS analysis revealed a nonlinear association between age and the progression of persistent and chronic ITP (p = 0.0012), with two inflection points at approximately 3.75 and 8 years. The risk of progression increased rapidly before 3.75 years, stabilized between 3.75 and 8 years, and rose sharply thereafter, indicating that age ≥ 8 years was at particularly high risk. Neither IVIG administration (OR = 0.99, 95% CI: 0.65-1.53, p = 0.98) nor GC tapering time ≥ 7 days (OR = 1.62, 95% CI: 0.76-3.43, p = 0.21) was significantly associated with long-term prognosis.
Conclusion:
Age was an independent risk factor for progression to persistent and chronic ITP. Short-course GC regimens could be a rational therapeutic alternative for pediatric ITP patients without severe manifestations or life-threatening bleeding, and age-stratified risk management merits clinical consideration.
