Abstract
Background: Corticosteroid therapy is the first-line treatment of immune thrombocytopenia (ITP) with moderate to severe thrombocytopenia or significant bleeding. This adds a layer of complexity when treating diabetic patients as steroid therapy can worsen glycemic control and increase the risk of diabetic ketoacidosis. This study aims to identify if a coexisting diagnosis of diabetes, either type-1 or type-2, correlates with increased mortality, cost and length of stay, among other outcomes, for hospitalized patients with ITP.
Methods: The National Inpatient Sample (NIS) database (2017–2021) of the Healthcare Cost and Utilization Project (HCUP) was used. We applied the discharge weight “DISCWT” provided in the database to generate the national estimates. Pearson Chi-square test for categorical variables and Student's t- tests/one-way ANOVA for continuous variables were applied to compare the baseline demographics and hospital characteristics between the groups. Mortality was the primary outcome while length of stay, total hospitalization charges, development of acute deep venous thrombosis (DVT) or acute pulmonary embolism (PE) constituted the secondary outcomes. Multivariate linear and logistic regression models were used to adjust for confounders such as ages, tobacco use, hypertension, chronic obstructive pulmonary disease, ischemic heart disease, and prior cerebrovascular accident.
Results: 61,994 patients were hospitalized for ITP between 2017 and 2021, 16,747 out of these patients had a diagnosis of type-1 or type-2 diabetes mellitus. After adjusting for confounders, there were higher odds of mortality in patients with diabetes (aOR:1.36; CI 1.25 - 1.48; p-value <0.001). Diabetic patients also had a higher total hospitalization charges ($23,128 vs $21,547) (aOR:1.07; CI 1.04 - 1.1; p-value <0.001) and a higher length of stay (7.0 days vs 5.95 days) (aOR:1.18; CI 1.15 - 1.2; p-value <0.001). There were no significant differences in the odds of developing an acute DVT or PE during the hospitalization between the two groups.
Conclusion: Type 1 or type 2 diabetic patients hospitalized with ITP have higher odds of mortality, higher mean cost of hospitalization and longer length of stay compared to patients without diabetes. The American Society of Hematology guidelines for treatment of ITP express concerns about the use of corticosteroids in patients with diabetes, yet little evidence exists to guide clinical practice. The higher odds of mortality in diabetic patients with ITP may be a result of worsened glycemic control during steroid use or from the use of second-line therapies such as IV immunoglobulin if steroids are avoided. Complications of hyperglycemia and closer lab monitoring could be a contributing factor to longer length of stay and higher mean cost of hospitalizations. More data must be obtained to further evaluate the impact of ITP treatment in patients with diabetes.
