title: Immune thrombocytopenia in adults: a prospective cohort study of clinical features and predictors of outcome.
abstract: This prospective observational cohort study aimed to explore the clinical features of incident immune thrombocytopenia in adults and predictors of outcome, while determining if a family history of autoimmune disorder is a risk factor for immune thrombocytopenia. All adults, 18 years of age or older, recently diagnosed with immune thrombocytopenia were consecutively recruited across 21 hospital centers in France. Data were collected at diagnosis and after 12 months. Predictors of chronicity at 12 months were explored using logistic regression models. The association between family history of autoimmune disorder and the risk of developing immune thrombocytopenia was explored using a conditional logistic regression model after matching each case to 10 controls. One hundred and forty-three patients were included: 63% female, mean age 48 years old (Standard Deviation=19), and 84% presented with bleeding symptoms. Median platelet count was 10×10(9)/L. Initial treatment was required in 82% of patients. After 12 months, only 37% of patients not subject to disease-modifying interventions achieved cure. The sole possible predictor of chronicity at 12 months was a higher platelet count at baseline [Odds Ratio 1.03; 95%CI: 1.00, 1.06]. No association was found between outcome and any of the following features: age, sex, presence of either bleeding symptoms or antinuclear antibodies at diagnosis. Likewise, family history of autoimmune disorder was not associated with incident immune thrombocytopenia. Immune thrombocytopenia in adults has been shown to progress to a chronic form in the majority of patients. A lower platelet count could be indicative of a more favorable outcome.
authors.affiliation: LASER, Paris, France.
authors.forename: Lamiae
authors.initials: L
authors.lastname: Grimaldi-Bensouda
authors.affiliation: LASER, Paris, France clementine.nordon@la-ser.com.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Nordon
authors.affiliation: Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, Créteil, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Michel
authors.affiliation: Service de Médecine Interne, Hôpital Haut-Lévêque, Pessac; Université Bordeaux 2, Bordeaux, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Viallard
authors.affiliation: IUCT Oncopôle, Toulouse, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Adoue
authors.affiliation: Service de Médecine Interne, CHU Jean Minjoz, Besançon, France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Magy-Bertrand
authors.affiliation: Service de Médecine Interne, Hôpital de la Timone, Marseille, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Durand
authors.affiliation: Département d'Hématologie Clinique, Hôpital St-Eloi, Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Quittet
authors.affiliation: Service de Médecine Interne, Hôpital Saint Antoine; Hôpitaux Universitaires de l'Est Parisien, AP-HP Université Paris 6, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
authors.affiliation: Service de Médecine Interne et Immunologie Clinique, INSERM 1098, CHU Bocage Central, Dijon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bonnotte
authors.affiliation: Service de Médecine Interne CHU Jean Verdier, Université Paris 13, Assistance Publique-Hôpitaux de Paris (AP-HP), Bondy, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Morin
authors.affiliation: Service de Médecine Interne, Hôpital Cochin, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Morel
authors.affiliation: Service de Médecine Interne, Hôpital Cochin, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.affiliation: Service Hématologie, CHU Morvan 29609 Brest Cedex, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Pan-Petesch
authors.affiliation: Service des Urgences, Centre Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Khellaf
authors.affiliation: Service de Médecine Interne, CHU Rennes, France.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Perlat
authors.affiliation: Université Paris-Diderot, Paris; Assistance Publique Hôpitaux de Paris; INSERUM U1149, Paris, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Sacre
authors.affiliation: Service de Biothérapie, Hôpital Necker, APHP, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Lefrere
authors.affiliation: LASER, Paris, France.
authors.forename: Lucien
authors.initials: L
authors.lastname: Abenhaim
authors.affiliation: Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, Créteil, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Godeau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D010641:Phenotype; D011159:Population Surveillance; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D055815:Young Adult