Clinical Epidemiology, Treatment Outcome and Mortality Rate of Newly Diagnosed Immune Thrombocytopenia in Adult Multicentre Study in Malaysia

Figures & data

Table 1 Demographic Characteristics of ITP Patients

Variables	Study Subjects, n (%)
Total number of patients	500 (100)
Age at diagnosis, year
18–29	163 (32.6)
30–39	109 (21.8)
40–49	69 (13.8)
50–59	69 (13.8)
60–69	56 (11.2)
70–79	27 (5.4)
≥ 80	7 (1.4)
Sex
Male	141 (28.2)
Female	359 (71.8)
Ethnic background
Malay	274 (54.8)
Chinese	122 (24.4)
Indian	68 (13.6)
Others	36 (7.2)
Charlson comorbidity index (CCI)
0	327 (65.4)
1	48 (9.6)
2	54 (10.8)
≥ 3	1 (14.2)
Concomitant drugs
Antiplatelet	19 (3.8)
Anticoagulant	13 (2.6)
NSAIDS	0 (0.0)
Type of ITP
Primary	385 (77.0)
Secondary	115 (23.0)
Platelet count at presentation (x10^9/L), median	17.5 [0–99]
Bleeding symptoms at ITP diagnosis
Yes	265 (53.0)
No	235 (47.0)

Abbreviations: ITP, immune thrombocytopenia; NSAIDS, non-steroidal anti-inflammatory drugs.

Figure 1 Distribution of age and gender of ITP patients.

Figure 2 Bleeding symptoms at presentation by anatomical site.

Figure 3 Platelet count at the time of ITP diagnosis. The vertical line indicates a platelet count of 20 × 10⁹/L.

Table 2 Laboratory Test Results

Test	Positive (%)	Negative (%)	Not Done (%)
Antiphospholipid antibodies	24 (4.8)	39 (7.8)	437 (87.4)
Antinuclear antibodies	129 (25.8)	267 (53.4)	104 (20.8)
Rheumatoid factor	18 (3.6)	47 (9.4)	435 (87.0)
Hepatitis B	14 (2.8)	433 (86.6)	53 (10.6)
Hepatitis C	5 (1.0)	441 (88.2)	54 (10.8)
HIV	11 (2.2)	411 (82.2)	78 (15.6)
Helicobacter pylori	6 (1.2)	8 (1.6)	486 (97.2)

Abbreviation: HIV, human immunodeficiency virus.

Table 3 Treatment Exposure at Diagnosis

Treatment	All ITP, n = 500
General data
No therapy, number (%)	97 (19.4)
Platelet transfusion at diagnosis, number (%)	104 (20.8)
First-line therapy, number (%)
IV Methylprednisolone (pulses) + corticosteroids	258 (51.6)
IV Hydrocortisone + corticosteroids	3 (0.6)
IV Dexamethasone + corticosteroids	2 (0.4)
IVIg + corticosteroids	136 (27.2)
Corticosteroids alone	398 (79.6)
Second-line treatments (%)	156 (31.2)
Azathioprine	134 (26.8)
Eltrombopag	27 (5.4)
Danazol	45 (9.0)
MMF	25 (5.0)
Vincristine	3 (2.6)
Cyclosporin	8 (1.6)
Cyclophosphomide	2 (0.4)
Rituximab	35 (7.0)
Splenectomy	9 (1.8)
Initial response rate to first line treatments, with reference to;	All patients, n = 403
At 3 months, number (%)
Complete response	147 (36.5)
Partial response	91 (22.6)
No response	60 (14.9)
No count (loss of follow-up)	105 (26.1)
At 12 months, number (%)
Complete response	105 (26.1)
Partial response	75 (18.6)
No response	54 (13.4)
No count (loss of follow-up)	169 (41.9)

Abbreviations: IV, intravenous; IVIg, intravenous immunoglobulin; MMF, mycophenolate mofetil.

Table 4 Mortality Risk of ITP Patients

Variables	Dead	Alive	Relative Risk (95% CI)	P value
Age, years
<60 (n = 410)	36 (8.8)	374 (91.2)	0.4 (0.3–0.7)
≥60 (n = 90)	19 (21.1)	71 (78.9)	2.8 (1.5–5.1)	0.001
Gender
Male (n = 141)	24 (17.0)	117 (83.0)	2.0 (1.2–3.2)	0.007
Female (n = 359)	31 (8.6)	328 (91.4)	0.5 (0.3–0.8)
Initial platelet
<20 × 10^9/L (n = 257)	26 (10.1)	231 (89.9)	0.8 (0.5–1.4)	0.516
≥20 × 10^9/L (n = 243)	29 (11.9)	214 (88.1)	1.2 (0.7–2.1)
Bleeding at diagnosis
Yes (n = 265)	30 (11.3)	235 (88.7)	1.1 (0.6–1.9)	0.808
No (n = 235)	25 (10.6)	210 (89.4)	0.9 (0.6–1.6)
Severe bleeding at diagnosis
Yes (n = 82)	17 (20.7)	65 (79.3)	2.6 (1.4–4.9)	0.002
No (n = 418)	38 (9.1)	380 (90.9)	0.4 (0.3–0.7)
Charlson comorbid index
0 (n = 327)	20 (6.1)	307 (93.9)	0.3 (0.2–0.5)
≥1 (n = 173)	35 (20.2)	138 (79.8)	3.9 (2.2–7.0)	0.000
Type of ITP
Primary (n = 385)	35 (9.1)	350 (90.9)	0.5 (0.3–0.9)
Secondary (n = 115)	20 (17.4)	95 (82.6)	2.1 (1.2–3.8)	0.013
Anticoagulant
Yes (n = 13)	3 (23.1)	10 (76.9)	2.5 (0.7–9.4)	0.159
No (n = 487)	52 (10.7)	435 (89.3)	0.5 (0.2–1.3)
Antiplatelet
Yes (n = 19)	2 (10.5)	17 (89.5)	1.0 (0.2–4.2)	0.946
No (n = 481)	53 (11.0)	428 (89.0)	1.0 (0.3–4.0)

Abbreviations: ITP, immune thrombocytopenia; CI, confidence intervals.

Table 5 Incidence of Adult ITP Patients in General Population

Year	Study	Country	Design	Incidence	Year of Studied
1999	Frederiksen et al^Citation38	Denmark	Retrospective by ICD code	2.68	1973–1995
2009	Marieke Schoonen et al^Citation6	England	Retrospective by administrative data	3.90	1990–2005
2010	Terrell et al^Citation30	Europe	Critical review of published reports	3.30	1966–2009
2010	Kurata et al^Citation28	Japan	Retrospective by registered data	2.16	2004–2007
2014	Michel et al^Citation39	France	Retrospective by cohort study	4.00	2009–2012
2017	Lee et al^Citation40	Korea	Retrospective by registered data	1.50	2010–2014
2018	Hung et al^Citation41	Taiwan	Retrospective by registered data	2.00	2006–2013

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