Short-Term Infection Risk and Clinical Impact in Immune Thrombocytopenia After Treatment

Abstract

AbstractAbstract 4652Patient with refractory ITP have increased mortality compared with the normal population. Apart from major bleeding, infection was a major risk of death of these patients.1However, infections after diagnosis of immune thrombocytopenia are less addressed in the literature and its clinical impact on outcome of patients with ITP has not been well-addressed. This study aimed to characterize risk of infection events after diagnosis of ITP and its impact on outcome of these patients. We retrospectively evaluated 239 patients (109 men, 130 women; medium age: 63 yr) diagnosed between Jan 1, 1997 to Aug 31, 2011. Every patient received at least steroid treatment according to platelet count or bleeding symptoms after diagnosis. Infection event occurred in 59 patients (24.7%) within 6 months after diagnosis. Multivariate analysis revealed that age (>65 yr) was the most important risk factor regarding to infection (p=0.048, 95% CI 1.005 to 4.007). 1-year mortality rate after ITP diagnosis was significantly higher in those patients with infection after steroid treatment (p<0.001). We conclude that elderly patients with ITP are more prone to infections which have negative impact on post-diagnosis 1 year survival.Table 1The Demographic and Clinical Characteristics of Patients With Immune ThrombocytopeniaPatient characteristicAll patients (n=239)Sex, no. of patients (%)Male109 (45.6%)Female130 (54.4%)Medium age, y63.0 (18∼97)Medium follow-up period, months19.08 (0.1∼155)Thrombocytopenia1 no. of patients (%)195 (81.6%)Severe44 (18.4%)Moderate20 (8.4%)Evan's syndrome, no. of patients (%)19 (7.9%)Splenectomy, no. of patients (%)35 (14.6%)Comorbidity, no. of patients (%)74 (31%)DM12 (5%)HTN8 (3.3%)CKD12 (5%)CHF8 (3.3%)CVA96 (40.2%)COPD59 (24.7%)Any13 (5.4%)Infectious event, no. of patients (%)11 (4.6%)Total patient2 (0.8%)Mortality, no. of patients (%)Total numbersDeath due to infectionDeath due to bleeding1Moderate thrombocytopenia= platelet counts between 30.0 × 109/L and 100.0 × 109/L; severe thrombocytopenia counts below 30.0 × 109/L.Table 2Clinical Characteristics of Infection EventsPatient characteristicAll events (n=70)Infectious event, no. (%)Total event70Pneumonia31 (44.2%)UTI13 (15.6%)Herpes zoster9 (12.8%)Cellulitis7 (10.0%)Others110 (14.3%)Pathogens no. of eventEvents with definite cultured pathogen29Staphylococcus aureus8Klebsiella pneumonia6Yeast26Pseudomonas aeruginosa5Acinetobacter baumannii4Stenotrophomonas maltophilia4E. coli3Enterobacter spp.3Others35Infection event date1st month23 (32.9%)2nd month17 (24.3%)3rd month7 (10.0%)4th month8 (11.4%)5th month6 (8.5%)6th month9 (12.9%)1Other infection includes oral candidiasis (2), cholangitis (1), fungemia (1), bacteremia (1), intraabdominal abscess (1), facial abscess (1), osteomyelitis (1), pseudomembranous colitis (1), acute suppprative periodontitis (1).2Including Candida albicans and Aspergillus.3Other pathogen including Streptococcus agalactiae (1), Serratia spp (1) Clostridium dificile (1), Chryseobacterium meningosepticum (1), gram positive cocci (1).Table 3Baseline Characteristics of Patients with or without InfectionCharacterNo infection (n=180)Infection (n=59)p valueSex0.006*M73 (40.6%)36 (61.0%)F107 (59.4%)23 (39.0%)Age0.616Medium5773Range18∼9023∼97Thrombocytopenia0.268Moderate36 (20.0%)8 (13.6%)Severe144 (80.0%)51 (86.4%)Evan's syndrome14 (7.8%)6 (10.2%)0.565Splenectomy13 (7.2%)6 (10.2%)0.468CormobidityDM21 (11.7%)14 (23.7%)0.023*HTN51 (28.3%)23 (39.0%)0.125CKD6 (3.3%)6 (10.2%)0.037*CHF5 (2.8%)3 (5.1%)0.393CVA8 (4.4%)4 (6.8%)0.476COPD4 (2.2%)4 (6.8%)0.095Any64 (35.8%)31 (52.5%)0.022*ANC<100049 (27.2%)26 (44.1%)0.016*Response10.001*CR+PR151 (83.9%)38 (64.4%)NR29 (16.1%)21 (35.6%)1Response: complete response (CR) partial response (PR) no response (NR).Table 4Multivariate Analysis for the Short Term (Within 6 Months) Infection Risk in Patient with ITPDependant variableOdds ratioP value95% confidence intervalLower boundUpper boundAge >652.2050.048*1.0054.077ALC<10001.8070.0660.9613.399Any cormobidity1.3740.3570.6992.699 [Display omitted] Disclosures:No relevant conflicts of interest to declare.