Objective: Immune thrombocytopenia (ITP) is an acquired hematological disorder that occurs when the body produces antiplatelet antibodies that bind to circulating platelets, leading to their destruction. This study aims to analyze outcomes of ITP hospitalizations in conditions with increased risk of autoimmunity, using data from the National inpatient sample (NIS) database from 2016 to 2020.

Methods: Data regarding patients demographics, comorbidities and hospital outcomes was obtained from the NIS database 2016-2020, using international classification of diseases (ICD) code, for hospitalizations related to ITP in patients with conditions associated with a higher risk of autoimmunity, including Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), Sjogren's Syndrome, Myasthenia Gravis, and Common Variable Immune Deficiency (CVID), as well as in those with Hodgkin Lymphoma, Non-Hodgkin Lymphoma, and Pregnancy. In order to compare the baseline demographics and hospital outcomes, Pearson Chi-square test was used for categorical variables and student T-Test or one-way ANOVA was used for continuous variables, with non-parametric alternatives applied when appropriate. Significance was set at <0.05.

Results: A total of 6,060 patients with ITP and conditions associated with a higher autoimmunity risk were analyzed: SLE (49.50%), RA (18.73%), Sjogren's (8.09%), Myasthenia Gravis (1.24%), CVID (4.04%), Hodgkin Lymphoma (3.05%), Non-Hodgkin Lymphoma (14.60%), and Pregnancy (0.74%). Non-Hodgkin lymphoma had the highest proportion of older patients while SLE and Sjogren were the groups with the highest number of females. SLE was the only group with a higher percentage of African-Americans (41.65%) compared to Whites (31.50%). Regarding outcomes, the highest in-hospital mortality was among Hodgkin Lymphoma (2.70%, p=0.011), while the highest risk of respiratory failure was among non-Hodgkin lymphoma patients (5.08%, p<0.001). The highest number of major bleeding events (30%, p<0.001) and use of IVIG (24.50%, p=0.0009) was among SLE patients. There were no significant differences in the use of PLEX (p = 0,091) between groups. Hospitalization costs and length of stay were significantly higher for Hodgkin Lymphoma ($23,855.80, 4 days, p<0.001), followed by Non-Hodgkin Lymphoma ($19,379.93, 4 days).

Conclusion: This study highlights significant differences in outcomes for ITP patients with conditions that increase the risk for autoimmunity. Lymphoma patients had the highest in-hospital mortality, risk for mechanical ventilation, as well as the highest hospitalization costs and length of stay, while major bleeding was significantly more common among SLE patients. Further research is needed to assess the potential implications of these different conditions and the role they play in ITP outcomes.

Disclosures

No relevant conflicts of interest to declare.

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2024
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