Developing and validating a mortality prediction model for ICH in ITP: a nationwide representative multicenter study.

Abstract

Intracranial hemorrhage (ICH) is a rare and life-threatening hemorrhagic event in patients with immune thrombocytopenia (ITP). However, its mortality and related risk factors remain unclear. Herein, we conducted a nationwide multicenter real-world study of ICH in adult ITP patients. According to data from 27 centers in China from 2005 to 2020, the mortality rate from ICH was 33.80% (48/142) in ITP adults. We identified risk factors by logistic univariate and multivariate logistic regression for 30-day mortality in a training cohort of 107 patients as follows: intraparenchymal hemorrhage (IPH), platelet count ≤10 × 109/L at ICH, a combination of serious infections, grade of preceding bleeding events, and Glasgow coma scale (GCS) level on admission. Accordingly, a prognostic model of 30-day mortality was developed based on the regression equation. Then, we evaluated the performance of the prognostic model through a bootstrap procedure for internal validation. Furthermore, an external validation with data from a test cohort with 35 patients from 11 other centers was conducted. The areas under the receiver operating characteristic (ROC) curves for the internal and external validation were 0.954 (95% confidence interval [CI], 0.910-0.998) and 0.942 (95% CI, 0.871-1.014), respectively. Both calibration plots illustrated a high degree of consistency in the estimated and observed risk. In addition, the decision curve analysis showed a considerable net benefit for patients. Thus, an application (47.94.162.105:8080/ich/) was established for users to predict 30-day mortality when ICH occurred in adult patients with ITP.

• Authors: Shan Chong, Peng Zhao, Rui-Bin Huang, Hu Zhou, Jia-Ning Zhang, Ming Hou, Yi Liu, Hong-Xia Yao, Ting Niu, Jun Peng, Ming Jiang, Yan-Qiu Han, Jian-Da Hu, Ze-Ping Zhou, Lin Qiu, Lian-Sheng Zhang, Xin Wang, Hua-Quan Wang, Ru Feng, Lin-Hua Yang, Liang-Ming Ma, Shun-Qing Wang, Pei-Yan Kong, Wen-Sheng Wang, Hui-Ping Sun, Jing Sun, He-Bing Zhou, Tie-Nan Zhu, Li-Ru Wang, Jing-Yu Zhang, Qiu-Sha Huang, Hai-Xia Fu, Ye-Jun Wu, Yue-Ying Li, Qian-Fei Wang, Qian Jiang, Hao Jiang, Jin Lu, Xiao-Jun Huang, Xiao-Hui Zhang
• Journal: Blood advances (Blood Adv) Vol. 6 Issue 14 Pg. 4320-4329 (07 26 2022) ISSN: 2473-9537 [Electronic] United States
• PMID: 35679462 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

Topics

• Adult
• Cerebral Hemorrhage (complications)
• Glasgow Coma Scale
• Humans
• Intracranial Hemorrhages (etiology)
• Purpura, Thrombocytopenic, Idiopathic (complications, epidemiology)
• ROC Curve