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Risk factors for intracranial hemorrhage in older ITP patients identified

Published: February 3rd 2021

medwireNews: Chinese researchers have identified predictive and prognostic factors for intracranial hemorrhage (ICH) in immune thrombocytopenia (ITP) patients older than 60 years of age. 

“ICH is a devastating complication of ITP,” with a high mortality rate of 79%, explained Jianing Zhang (Peking University People’s Hospital, Beijing) in a poster presentation at the virtual 62nd American Society of Hematology Annual Meeting and Exposition.

However, the morbidity is low, at less than 1%, “which makes general prophylaxis unrealistic” and risk stratification essential, he said, further noting that “few studies have analyzed the risk factors and outcomes in ICH in elderly ITP patients.”

The researchers therefore conducted a case–control study comprising 44 individuals with a diagnosis of primary ITP before the onset of ICH, who were matched by diagnosis time and ITP duration to 88 patients without ICH.

In multivariate analysis, the presence at baseline of life-threatening bleeding (defined as bleeding causing hemorrhagic shock or daily blood loss >2 g/dL) or head trauma was associated with a significantly increased risk for ICH, at hazard ratios (HRs) of 13.077 and 9.753, respectively.

ITP duration of less than 7 days and a platelet count of 25,000/μL or lower at ITP diagnosis were also significantly associated with an elevated ICH risk, with respective HRs of 6.741 and 3.389.

Multivariate analysis of risk factors for ICH in older ITP patients
Variable Hazard ratio p value
Life-threatening bleeding*
13.077
0.041
Head trauma
9.753
0.047
ITP duration <7 days
6.741
0.020
Platelet count (≤25,000 vs >25,000/µL)
3.389
0.013
Abbreviations: ITP, immune thrombocytopenia

*Any bleeding that caused hemorrhagic shock or a hemoglobin loss of more than 2 g/dL per day

Source: Jia-Ning Zhang, Peng Zhao, Kaiyan Liu, et al. Risk and Prognostic Factors for Intracranial Hemorrhage in Elderly Patients with Immune Thrombocytopenia. 62nd ASH Annual Meeting and Exposition; 2020 Dec 5–8: Abstract number 2665

A simple predictive model based on these four factors successfully stratified participants into low- (0 points), intermediate- (1–3 points), and high-risk (≥4 points) groups, reported Zhang, such that the incidence of ICH varied significantly by group, at rates of 13.3%, 36.5%, and 84.6%, respectively.

The investigators also assessed prognostic factors for ICH, finding that only skin bleeding was associated significantly with poor prognosis in a multivariate model (HR=0.060), with no significant associations observed for age, platelet count, or ITP duration.

Further research into the prognostic factors of ICH in this patient population is required, concluded Zhang.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

62nd ASH Annual Meeting and Exposition; 5–8 December 2020

Author: Shreeya Nanda

Credits © JFalcetti/iStock

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