title: Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis.
abstract: Childhood immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. Most children recover within 6 to 12 months, but individual course is difficult to predict. We performed a systematic review and meta-analysis to identify predictors of chronic ITP. We found 1399 articles; after critical appraisal, 54 studies were included. The following predictors of chronic ITP in children, assessed in at least 3 studies, have been identified: female gender (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.04-1.31), older age at presentation (age ≥11 years; OR 2.47, 95% CI 1.94-3.15), no preceding infection or vaccination (OR 3.08, 95 CI 2.19-4.32), insidious onset (OR 11.27, 95% CI 6.27-20.27), higher platelet counts at presentation (≥20 × 10(9)/L: OR 2.15, 95% CI 1.63-2.83), presence of antinuclear antibodies (OR 2.87, 95% 1.57-5.24), and treatment with a combination of methylprednisolone and intravenous immunoglobulin (OR 2.67, 95% CI 1.44-4.96). Children with mucosal bleeding at diagnosis or treatment with intravenous immunoglobulin alone developed chronic ITP less often (OR 0.39, 95% CI 0.28-0.54 and OR 0.71, 95% CI 0.52-0.97, respectively). The protective effect of intravenous immunoglobulin is remarkable and needs confirmation in prospective randomized trials as well as future laboratory studies to elucidate the mechanism of this effect.
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands;
authors.forename: Katja M J
authors.initials: KM
authors.lastname: Heitink-Pollé
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands;
authors.forename: Joyce
authors.initials: J
authors.lastname: Nijsten
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands;
authors.forename: Chantal W B
authors.initials: CW
authors.lastname: Boonacker
authors.affiliation: Department of Immunohematology, Sanquin Research, Amsterdam, The Netherlands; and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Masja
authors.initials: M
authors.lastname: de Haas
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands;
authors.forename: Marrie C A
authors.initials: MC
authors.lastname: Bruin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D019411:Clinical Laboratory Techniques; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012307:Risk Factors