Predictors for splenectomy among patients with primary chronic immune thrombocytopenia: a population-based cohort study from Denmark
- 111 Downloads
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.
KeywordsChronic immune thrombocytopenia Splenectomy Cohort study Risk
This study was supported by Amgen and received unrestricted grants from the Karen Elise Jensen Foundation.
- 1.Beardsley DS (2006) ITP in the 21st century. Hematol Am Soc Hematol Educ Program, pp 402–407Google Scholar
- 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.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