Influencing factors and construction of risk prediction model of immune thrombocytopenia in children

doi:10.11958/20221631

Abstract

Abstract:

Objective To study factors influencing the outcome of immune thrombocytopenia (ITP) in children, and construct a risk prediction model. Methods A total of 166 children with ITP were included in this study. Clinical characteristics and laboratory indicators of children with different outcomes were comparatively analyzed. Multivariate Logistic regression analysis was performed to screen factors influencing the outcome of children with ITP, and a risk prediction model was constructed based on analysis results. Hosmer-Lemeshow tested the goodness of fit of the model. The receiver operating characteristic (ROC) curve was plotted to analyze the predictive performance of the model. Results There were 118 children with good outcomes and 48 children with poor outcomes. Compared with the good outcome group, the proportions of age ≥1, ANA positive at first diagnosis and blood urea nitrogen (BUN) level were higher in the poor outcome group, while the proportion of platelet count (PLT) ≥20×10⁹/L at first diagnosis, absolute lymphocyte count (ALC) at first diagnosis and the percentage of megakaryocytes in bone marrow at first diagnosis were lower in the poor outcome group (P<0.05). Multivariate Logistic regression analysis showed that age ≥1 (95% CI: 1.358-83.563) and higher BUN level (95% CI: 4.013-32.615) were risk factors for disease outcome in children with ITP. PLT ≥20×10⁹/L at initial diagnosis (95% CI: 0.036-0.519) and higher ALC at initial diagnosis (95% CI: 0.197-0.571) were protective factors for disease outcome in children with ITP. Homser-lemeshow test showed χ²=8.486, P=0.387. The AUC of this model in predicting the outcome of children with ITP was 0.963 (95% CI: 0.934-0.991, P<0.001), and the sensitivity and specificity were 95.83% and 88.98%. Conclusion Age ≥1 and higher BUN level are risk factors for disease outcome in children with ITP. PLT ≥20×10⁹/L at initial diagnosis and higher ALC level at initial diagnosis are protective factors. The risk prediction model constructed according to these influencing factors has good predictive valuse for disease outcome of children with ITP.

Key words: thrombocytopenia, neonatal alloimmune, prognosis, risk factors, risk prediction model

CLC Number:

R725.582

Figures/Tables 5

References 19

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组别	n			性别（男/女）			年龄（<1岁/≥1岁）		诊断前病程（<3 d/≥3 d）		ITP 家族史
转归良好组	118			73/45			42/76		63/55		1（0.85）
转归不良组	48			27/21			2/46		21/27		2（4.17）
χ²				0.449			17.299^＊＊		1.268		0.661
组别		前驱诱因			初诊ANA阳性			初诊PLT≥20×10⁹/L
转归良好组		30（25.42）			20（16.95）			78（66.10）
转归不良组		6（12.50）			20（41.67）			7（14.58）
χ²		3.356			11.398^＊＊			36.245^＊＊
组别			初诊ALC/ （×10⁹/L）			初诊骨髓巨核细胞数/（个/片）				初诊骨髓产板巨核细胞百分比/%
转归良好组			5.32±1.51			402.95±98.04				17.50±4.07
转归不良组			3.68±0.83			363.83±131.69				16.16±3.75
χ²或t			8.943^＊＊			1.859				2.035^＊

组别	n			性别（男/女）			年龄（<1岁/≥1岁）		诊断前病程（<3 d/≥3 d）		ITP 家族史
转归良好组	118			73/45			42/76		63/55		1（0.85）
转归不良组	48			27/21			2/46		21/27		2（4.17）
χ²				0.449			17.299^＊＊		1.268		0.661
组别		前驱诱因			初诊ANA阳性			初诊PLT≥20×10⁹/L
转归良好组		30（25.42）			20（16.95）			78（66.10）
转归不良组		6（12.50）			20（41.67）			7（14.58）
χ²		3.356			11.398^＊＊			36.245^＊＊
组别			初诊ALC/ （×10⁹/L）			初诊骨髓巨核细胞数/（个/片）				初诊骨髓产板巨核细胞百分比/%
转归良好组			5.32±1.51			402.95±98.04				17.50±4.07
转归不良组			3.68±0.83			363.83±131.69				16.16±3.75
χ²或t			8.943^＊＊			1.859				2.035^＊

组别	n	APTT/s	FIB/（g/L）		AT-Ⅲ/%		TT/s		D-D/（μg/L）		FDP/（mg/L）		ALP/（U/L）			TP/（g/L）
转归良好组	118	29.63±4.51	2.22±0.66		102.50±15.88		18.75±2.54		0.47（0.29，1.00）		2.60（1.70，5.53）		215.00（170.75，260.50）			67.20±7.81
转归不良组	48	30.53±4.09	2.37±0.65		101.21±12.57		18.20±1.85		0.45（0.27，0.66）		2.25（1.53，4.15）		198.00（150.25，258.50）			67.63±5.70
t或Z		1.195	1.316		0.499		1.374		1.091		0.749		0.846			0.388
组别	GGT/（U/L）			TB/（μmol/L）		AGR		BUN/ （mmol/L）		UA/（μmol/L）		LDH/（U/L）		CHE/ （kU/L）	GLU/ （mmol/L）
转归良好组	12.00（10.00，16.25）			8.95（6.80，12.40）		1.80±0.51		3.29±0.68		227.96±79.48		485.50（275.00，760.50）		8.34±1.92	5.66±1.22
转归不良组	11.50（10.00，13.00）			8.25（6.60，10.33）		1.75±0.35		4.46±0.73		229.29±57.78		486.00（253.75，647.25）		8.11±1.98	5.58±0.87
Z或t	0.980			1.155		0.738		9.769^＊＊		0.105		1.029		0.708	0.407

组别	n	APTT/s	FIB/（g/L）		AT-Ⅲ/%		TT/s		D-D/（μg/L）		FDP/（mg/L）		ALP/（U/L）			TP/（g/L）
转归良好组	118	29.63±4.51	2.22±0.66		102.50±15.88		18.75±2.54		0.47（0.29，1.00）		2.60（1.70，5.53）		215.00（170.75，260.50）			67.20±7.81
转归不良组	48	30.53±4.09	2.37±0.65		101.21±12.57		18.20±1.85		0.45（0.27，0.66）		2.25（1.53，4.15）		198.00（150.25，258.50）			67.63±5.70
t或Z		1.195	1.316		0.499		1.374		1.091		0.749		0.846			0.388
组别	GGT/（U/L）			TB/（μmol/L）		AGR		BUN/ （mmol/L）		UA/（μmol/L）		LDH/（U/L）		CHE/ （kU/L）	GLU/ （mmol/L）
转归良好组	12.00（10.00，16.25）			8.95（6.80，12.40）		1.80±0.51		3.29±0.68		227.96±79.48		485.50（275.00，760.50）		8.34±1.92	5.66±1.22
转归不良组	11.50（10.00，13.00）			8.25（6.60，10.33）		1.75±0.35		4.46±0.73		229.29±57.78		486.00（253.75，647.25）		8.11±1.98	5.58±0.87
Z或t	0.980			1.155		0.738		9.769^＊＊		0.105		1.029		0.708	0.407

变量	β	SE	Waldχ²	P	OR（95%CI）
年龄	2.542	0.747	11.569	0.001	12.711（2.937~55.006）
初诊ANA	1.253	0.382	10.755	0.001	3.500（1.655~7.400）
初诊PLT	-2.435	0.453	28.925	<0.001	0.088（0.036~0.213）
初诊ALC	-0.973	0.178	29.861	<0.001	0.378（0.267~0.536）
初诊骨髓产板巨核细胞百分比	-0.085	0.044	3.731	0.053	0.918（0.842~1.001）
BUN	2.490	0.416	35.883	<0.001	12.058（5.339~27.232）