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

Author:

Chong Shan1234,Zhao Peng1234,Huang Rui-Bin5,Zhou Hu6,Zhang Jia-Ning7,Hou Ming8,Liu Yi9,Yao Hong-Xia10,Niu Ting11ORCID,Peng Jun8ORCID,Jiang Ming12,Han Yan-Qiu13,Hu Jian-Da14,Zhou Ze-Ping15,Qiu Lin16,Zhang Lian-Sheng17,Wang Xin18ORCID,Wang Hua-Quan19,Feng Ru20,Yang Lin-Hua21,Ma Liang-Ming22,Wang Shun-Qing23,Kong Pei-Yan24,Wang Wen-Sheng25,Sun Hui-Ping26,Sun Jing27,Zhou He-Bing28,Zhu Tie-Nan29,Wang Li-Ru30,Zhang Jing-Yu31,Huang Qiu-Sha14,Fu Hai-Xia1234,Wu Ye-Jun1234,Li Yue-Ying32,Wang Qian-Fei32,Jiang Qian1234,Jiang Hao1234,Lu Jin1234,Huang Xiao-Jun1234,Zhang Xiao-Hui1234

Affiliation:

1. 1Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China;

2. 2National Clinical Research Center for Hematologic Disease, Beijing, China;

3. 3Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China;

4. 4Collaborative Innovation Center of Hematology, Peking University, Beijing, China;

5. 5Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China;

6. 6Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China;

7. 7Peking University Cancer Hospital and Institute, Beijing, China;

8. 8Department of Hematology, Qilu Hospital, Shandong University, Jinan, China;

9. 9Department of Geriatric Hematology, Chinese People's Liberation Army General Hospital, Beijing, China;

10. 10Department of Hematology, Hainan General Hospital, Haikou, China;

11. 11Department of Hemotology, West China Hospital, Sichuan University, Chengdu, China;

12. 12Department of Hematology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China;

13. 13Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China;

14. 14Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China;

15. 15Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China;

16. 16Department of Hematology, The First Hospital of Jilin University, Changchun, China;

17. 17Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China;

18. 18Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China;

19. 19Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China;

20. 20Department of Hematology, Beijing Hospital, Ministry of Health, Beijing, China;

21. 21Department of Hematology, Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China;

22. 22Department of Hematology, Affiliated Shanxi Big Hospital of Shanxi Medical University, Taiyuan, China;

23. 23Department of Hematology, Guangzhou First People's Hospital, Guangzhou, China;

24. 24Xinqiao Hospital, The Third Military Medical University, Chongqing, China;

25. 25Department of Hematology, Peking University First Hospital, Beijing, China;

26. 26Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;

27. 27Nanfang Hospital, Nanfang Medical University, Guangzhou, China;

28. 28Beijing Luhe Hospital, Capital Medical University, Beijing, China;

29. 29Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;

30. 30Fuxing Hospital, Capital Medical University, Beijing, China;

31. 31Department of Hematology, Second Hospital of Hebei Medical University, Shijiazhuang, China; and

32. 32Key Laboratory of Genomic and Precision Medicine, Collaborative Innovation Center of Genetics and Development, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China

Abstract

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.

Publisher

American Society of Hematology

Subject

Hematology

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