Risk stratification and outcomes of intracranial hemorrhage in patients with immune thrombocytopenia under 60 years of age

Abstract

Intracranial hemorrhage (ICH) is a devastating complication of immune thrombocytopenia (ITP). However, information on ICH in ITP patients under the age of 60 years is limited, and no predictive tools are available in clinical practice. A total of 93 adult patients with ITP who developed ICH before 60 years of age were retrospectively identified from 2005 to 2019 by 27 centers in China. For each case, 2 controls matched by the time of ITP diagnosis and the duration of ITP were provided by the same center. Multivariate analysis identified head trauma (OR = 3.216, 95%CI 1.296–7.979, P =.012), a platelet count ≤ 15,000/μL at the time of ITP diagnosis (OR = 1.679, 95%CI 1.044–2.698, P =.032) and severe/life-threatening bleeding (severe bleeding vs. mild bleeding, OR = 1.910, 95%CI 1.088–3.353, P =.024; life-threatening bleeding vs. mild bleeding, OR = 2.620, 95%CI 1.360–5.051, P =.004) as independent risk factors for ICH. Intraparenchymal hemorrhage (OR = 5.191, 95%CI 1.717–15.692, P =.004) and a history of severe bleeding (OR = 4.322, 95%CI 1.532–12.198, P =.006) were associated with the 30-day outcome of ICH. These findings may facilitate ICH risk stratification and outcome prediction in patients with ITP.

Keywords:

• Immune thrombocytopenia
• intracranial hemorrhage
• outcome
• risk stratification

Acknowledgements

The authors would like to thank the patients and medical staff who participated in this study. We thank all investigators of the Cooperative ITP Working Group who provided us with their patient data. A complete membership list appears in “Appendix”. The authors also thank the department of medical record library for providing medical record provision.

Author Contribution

1. Zhao, M. Hou and Y. Liu analyzed the data and wrote the manuscript with X. Zhang; P. Zhao, H. Liu and Q. Huang performed statistical analysis; X. Zhang designed the study, analyzed the data, and edited the manuscript; the remaining authors contributed to data collection by identifying the cases and selecting the controls, and helped write the manuscript.

Declaration Of Interest Statement

The authors report no conflict of interest.

Supplementary Material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by Beijing Municipal Science and Technology Commission [No. Z171100001017084], National Natural Science Foundation of China [No. 81970113, No. 81730004 and No. 81670116], Beijing Natural Science Foundation [No. H2018206423, No. 7171013], the National Key Research and Development Program of China [No. 2017YFA0105500, No. 2017YFA0105503], and the Foundation for Innovative Research Groups of the National Natural Science Foundation of China [No. 81621001]. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.