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Annals of Hematology

, Volume 90, Issue 2, pp 207–212 | Cite as

Predictors for splenectomy among patients with primary chronic immune thrombocytopenia: a population-based cohort study from Denmark

  • Annette Østergaard JensenEmail author
  • Mette Nørgaard
  • Malene Cramer Engebjerg
  • Dora Körmendiné Farkas
  • Jon P. Fryzek
  • Sean Zhao
  • Henrik Toft Sørensen
Original Article

Abstract

We conducted a nationwide cohort study of adult Danish patients with primary chronic immune thrombocytopenia (cITP) to examine selected patient and clinical characteristics as predictors for splenectomy. We analyzed data from the Danish National Patient Registry and patient medical records from 1996 to 2007. Using Cox regression analyses, we calculated incidence rate ratios (IRRs) and associated 95% confidence intervals (CI) for splenectomy. We included 371 adult cITP patients. Of these, 87 patients (23%) underwent a splenectomy during a median of 3.6 years of follow-up. The majority (84%) of cITP patients who underwent splenectomy had splenectomy within the first year after cITP diagnosis. Predictors for splenectomy included age ≤75 years (adjusted 1-year IRR = 6.79 (95% CI, 2.10–21.90)) at least one platelet count ≤30 × 109/L (i.e., high disease activity; adjusted 1-year IRR = 2.67 (95% CI, 1.37–5.22)) during follow-up and year of cITP diagnosis in early period (1996–2001; adjusted 1 year IRR = 2.37 (95% CI, 1.46–3.85)). Presence of chronic comorbidity was associated with lower rates of splenectomy (adjusted 1 year IRR = 0.58 (95% CI, 0.33–1.05)). Our findings suggest that high disease activity and absence of chronic comorbidity may be associated with higher rates of splenectomy, and that contraindications for splenectomy (i.e., patients’ perceived frailty) cause the physicians to use the procedure cautiously.

Keywords

Chronic immune thrombocytopenia Splenectomy Cohort study Risk 

Notes

Acknowledgment

This study was supported by Amgen and received unrestricted grants from the Karen Elise Jensen Foundation.

References

  1. 1.
    Beardsley DS (2006) ITP in the 21st century. Hematol Am Soc Hematol Educ Program, pp 402–407Google Scholar
  2. 2.
    Kojouri K, Vesely SK, Terrell DR, George JN (2004) Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 104(9):2623–2634CrossRefPubMedGoogle Scholar
  3. 3.
    Rodeghiero F, Ruggeri M (2008) Is splenectomy still the gold standard for the treatment of chronic ITP? Am J Hematol 83(2):91CrossRefPubMedGoogle Scholar
  4. 4.
    Dolan JP, Sheppard BC, DeLoughery TG (2008) Splenectomy for immune thrombocytopenic purpura: surgery for the 21st century. Am J Hematol 83(2):93–96CrossRefPubMedGoogle Scholar
  5. 5.
    Frank L (2000) Epidemiology: when an entire country is a cohort. Science 287(5462):2398–2399CrossRefPubMedGoogle Scholar
  6. 6.
    Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH (1999) The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 46(3):263–268PubMedGoogle Scholar
  7. 7.
    George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, Blanchette VS, Bussel JB, Cines DB, Kelton JG et al (1996) Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 88(1):3–40PubMedGoogle Scholar
  8. 8.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383CrossRefPubMedGoogle Scholar
  9. 9.
    Boye J, Elter T, Engert A (2003) An overview of the current clinical use of the anti-CD20 monoclonal antibody rituximab. Ann Oncol 14(4):520–535CrossRefPubMedGoogle Scholar
  10. 10.
    Thomsen RW, Schoonen M, Farkas DK, Riis A, Jacobsen J, Fryzek JP, Sørensen HT (2009) Risk for hospital contact with infection in patients with splenectomy: a population-based cohort study. Ann Intern Med 151(8):546–555PubMedGoogle Scholar
  11. 11.
    Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A (2001) Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 97(9):2549–2554CrossRefPubMedGoogle Scholar
  12. 12.
    Mazzucconi MG, Arista MC, Peraino M, Chistolini A, Felici C, Francavilla V, Macale E, Conti L, Gandolfo GM (1999) Long-term follow-up of autoimmune thrombocytopenic purpura (ATP) patients submitted to splenectomy. Eur J Haematol 62(4):219–222CrossRefPubMedGoogle Scholar
  13. 13.
    Cooper N, Evangelista ML, Amadori S, Stasi R (2007) Should rituximab be used before or after splenectomy in patients with immune thrombocytopenic purpura? Curr Opin Hematol 14(6):642–646CrossRefPubMedGoogle Scholar
  14. 14.
    Akwari OE, Itani KM, Coleman RE, Rosse WF (1987) Splenectomy for primary and recurrent immune thrombocytopenic purpura (ITP). Current criteria for patient selection and results. Ann Surg 206(4):529–541CrossRefPubMedGoogle Scholar
  15. 15.
    Andersen TF, Madsen M, Loft A (1987) Validity of surgical information from the Danish National Patient Registry with special attention to the analysis of regional variations in hysterectomy rates. Ugeskr Laeger 149(36):2420–2422PubMedGoogle Scholar
  16. 16.
    Klith Heden KE, Jensen AO, Farkas DK, Nørgaard M (2009) Validity of a procedure to identify patients with chronic idiopathic thrombocytopenic purpura in the Danish National Registry of Patients. Clin Epidemiol 1:7–10Google Scholar
  17. 17.
    Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N et al (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 113(11):2386–2393CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Annette Østergaard Jensen
    • 1
    Email author
  • Mette Nørgaard
    • 1
  • Malene Cramer Engebjerg
    • 1
  • Dora Körmendiné Farkas
    • 1
  • Jon P. Fryzek
    • 2
  • Sean Zhao
    • 2
  • Henrik Toft Sørensen
    • 1
  1. 1.Department of Clinical EpidemiologyAarhus University HospitalÅrhus N.Denmark
  2. 2.Global Safety, Amgen Inc.Thousand OaksUSA

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