Risk Factors Of Adult Primary Immune Thrombocytopenia With Infection And Severe Hemorrhage

Objective:To analyze the clinical characteristics of patients with primary immune thrombocytopenia (ITP), to explore the risk factors for ITP infection or severe bleeding.Methods:Retrospective analyze the clinical data of 174 newly diagnosed patients with ITP in the Second Affiliated Hospital of Kunming Medical University from June 2000 to June 2016,the data were analyzed by SPSS 17.0 .Results: 174 cases of adult ITP patients,54 males and 120 females,the median age of 48 (18-85) years old,3cases(1.72%) died of infection,2 cases (1.15%) died of intracranial hemorrhage.32cases(18.4%)with infection,49 cases (28.2%) with severe bleeding.1.Clinical features of patients with and without infection in ITP: In the infection group and the non-infection group,the proportion of patients aged?60 years was 50.0%(16/32) and 30.3% (43/142), respectively, there was significant difference between the two groups(x2= 4.531,P = 0.033);the number of males was 50.0% (16/32) and 26.8%(38/142),respectively, there was significant difference between the two groups (x2 =6.590, P ? 0.010); ALC?1x109/L was 53.1% (17/32) and 23.2% (33/142),respectively,there was significant difference between the two groups(x2= 4.317,P =0.038);patients with diabetes mellitus (DM) was 25.0% (8/32) and 11.3% (16/142), respectively, there was a significant difference between the two groups (x2= 4.142,P =0.042).Univariate analysis showed that there was a significant difference in age,sex, diabetes mellitus(DM) and absolute lymphocyte count (ALC) between the infected group and the non-infected group (P<0.05);Multivariate logistic regression analysis showed that sex and the ALC value was an independent risk factor for infection in adult patients with ITP(P=0.014,OR:2.712,95%CI:1.222-6.018;P=0.048,OR:0.442,95%CI:0.196-0.995).2.Clinical features of patients with severe bleeding and no severe bleeding in ITP: In the severe hemorrhage group and the non-severe hemorrhagic group, the proportion of patients aged>60 years was 53.1% (26/49) and 24.8% (33/125), respectively, there was significant difference between the two groups(x2=11.165,P = 0.001); the proportion of patients with PLT<20x109/L was 73.5% (36/49) and 49.6%(62/125),respectively, there was significant difference between the two groups(x2= 8.153,P =0.004);the proportion of patients with previous history of bleeding was 34.7% (17/49)and 52.0% (65/125), respectively, there was significant difference between the two groups (x2= 4.231,P = 0.040);CCI?1 points were 59.2% (29/49) and 33.6% (42/125),respectively, there was significant difference between the two groups(x2= 9.539,P =0.002).Single factor analysis found age, newly diagnosed platelet count,CCI?1,the history of previous bleeding in the severe bleeding group and the absence of severe bleeding group have the existence of statistical significance (P<0.05), Multivariate logistic regression analysis showed that age (P=0.032,OR:2.292,95%CI: 1.074-4.888),the initial platelet count(P= 0.000,OR: 9.267,95% CI:3.119-26.599), CCI>1((P=0.002,OR: 3.215,95% CI: 1.512-6.834) and history of previous bleeding(P=0.031,OR:1.624,95% CI: 1.053-2.923)was an independent risk factor for patients with adult ITP who had severe bleeding.Conclusion:1. Gender, ALC is an independent risk factor for infection in adult ITP patients, which opportunely prevent and control infection in clinical practice and effectively assess the risk of infection in adult ITP patients.2.Age, newly diagnosed platelet count, CCI?1,previous history of bleeding is an independent risk factor for adult ITP patients with severe bleeding,which opportunely prevent and control severe bleeding in clinical practice,effectively assess the prognosis of patients with ITP and improve the prognosis of patients with ITP.