The Prevalence and Clinical Characteristics of Steroid Non-Responsive Immune Thrombocytopenia Patients in Chonburi Hospital
Abstract
Background: Immune Thrombocytopenia (ITP) is defined as platelet count < 100,000 cells per microliter in the absence of other causes of thrombocytopenia. Steroids remain the first-line therapy for ITP. The majority of patients respond to steroid therapy. However, 20-30% of the patients fail to respond and require alternative therapy with close monitoring of treatment.
Objectives: This study aimed to investigate the prevalence and factors associated with non-response to steroid treatment.
Methods: This study was a retrospective study including ITP patients aged ³ 15 years, who were treated with steroids as first-line treatment at hematology clinic or internal medicine inpatient ward at Chonburi hospital between 1 January 2017 and 31 December 2022. Data collection included age, gender, underlying disease, severity of bleeding and platelet count at time of diagnosis and after 4 weeks of treatment. Blood test results for HBsAg, Anti-HCV, Anti-HIV, ANA and the response status to steroids after 4 weeks were recorded. The study aimed to identify the factors associated with non-response to steroid treatment using Risk difference regression analysis.
Results: Of 168 ITP patients, 25 (14.88%) were non-responsive to steroid treatment. The mean age was 38 years. The majority of patients (73.8%) were female. From the multivariate analysis, we demonstrated that patients without bleeding or with non-severe bleeding at time of diagnosis [adjusted risk difference 0.14, p < 0.01], positive HBsAg [adjusted risk difference -0.21, p < 0.01] and positive ANA patients [adjusted risk difference -0.11, p = 0.04] were associated with non-response to steroid treatment.
Conclusion: The prevalence of steroid non-responsive ITP patients in Chonburi Hospital was 14.88%. Patients without bleeding or with non-severe bleeding at time of diagnosis, positive HBsAg and positive ANA patients were associated with non-response to steroid treatment, however further study is needed to determine the association.
Keywords : Immune thrombocytopenia, ITP, Steroids
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