Health-related quality of life and complications of corticosteroid treatment in patients with immune thrombocytopenia in two teaching hospitals in Ethiopia: A cross-sectional study

Abstract

Abstract Background Treatment of immune thrombocytopenia (ITP) is difficult and has a significant impact on health-related quality of life (HRQoL), and prolonged use of corticosteroids may have a negative impact on HRQoL. The prepuse of this study was to evaluate the impact of ITP on HRQoL in patients with ITP at Tikur Anbessa Specialized Hospital (TASH) and St. Paul's Hospital Millennium Medical College (SPHMMC). Methods The institutional-based cross-sectional study was conducted from November 15, 2022 to March 15, 2023 to recruit 214 study participants. Descriptive statistics were used to summarize the sociodemographic data and clinical and treatment-related characteristics. Linear regression analysis models were also used to identify predictive factors for HRQoL. A p-value of less than 0.05 was generally considered statistically significant. Results Most of the study participants were female 161(75.5%). Regarding treatment, the majority 172(80.4%) of study participants were taking prednisolone only, and 143(66.8%) of study participants had at least one side effect of corticosteroids during the entire treatment period. Predictive factors for a higher impact of ITP on HRQoL; all correlated variables explained 36.5% (adjusted R-squared = 0.365, P < 0.0001) of the variance and had a moderate impact on HRQoL. Of these, 15.4% of the variance (adjusted R-squared = 0.154, β = 0.392, P < 0.0001) was accounted for by emotion-related corticosteroid side effects. Furthermore, predictive factors for an increasingly higher impact of ITP on HRQoL were the development of emotionally related corticosteroid side effects (β = 0.392, 95% CI: 5.160–9.961, P < 0.001), the presence of fatigue during the assessment (β = 0.326, 95% CI: 4.394–9.475, P < 0.001), patients not taking cotrimoxazole prophylaxis treatment (β = 0.236, 95% CI: 2.236–6.570, P < 0.001), living far from the hematology clinic (outside Addis Ababa) (β = 0166, 95% CI: 1.107–5.114 P = 0.003), having epistaxis and wet purpura (mucosal bleeding) (β = 0.191, 95% CI: 0.091–4.259, P = 0.001), and skin symptoms (petechiae and ecchymosis) (β = 0.041, 95% CI: 0.091–4.259 P = 0.041) during diagnosis. Conclusion The impact of ITP on their energy levels and work life was high compared to the impact of ITP on daily life. The side effects of corticosteroids also affect the HRQoL of ITP patients.