Development and validation of a nomogram for steroid-resistance prediction in immune thrombocytopenia patients.

Abstract

OBJECTIVES:

Corticosteroid is first-line therapy in immune thrombocytopenia. However, nearly 30% of patients appear in steroid-resistance. Our research analyses the relevant indicators of patients and develops a risk prediction model to predict the poor response to steroid-therapy in ITP patients.

METHODS:

We collected data from 111 ITP patients admitted to Xiamen University Zhongshan Hospital from 2013 to 2019 as the training cohort and 65 ITP patients during 2019-2020 as the external validation cohort. Screening significant factors(P < 0.05) in univariate analysis, and further identified to be independent variables in multivariable logistic regression analysis. Incorporated the significant risk factors in and presented them with a nomogram based on independent risk predictors. The nomogram was assessed by receiver operating characteristics curves and decision curve analysis.

RESULTS:

We constructed a steroid-resistance prediction model based on the potential predictors including age, serum ferritin and expression of HBsAg. As a result, based on the area under the ROC curves, the training cohort (AUC: 0.718, 95% CI: 0.615-0.821) and the external validation cohort (AUC:0.799,95%CI:0.692-0.905), which displayed good discrimination. The decision curve showed that predicting the steroid-refractory risk in ITP patients using this nomogram with a range of the threshold probability between >16% and <70%. The nomogram appears good performance in predicting steroid-refractory ITP patients.

CONCLUSION:

Prediction model shows that elder patients with a high level of ferritin and positive expression of HBsAg may appear a high possibility of steroid-resistance. For these patients, TPO-RAs can be considered to help patients to get better treatment effects and develop a better health-related quality of life.

• Authors: Jieni Yu, Zhiqiang Xu, Yuanyuan Zhuo, Huahua Wei, Yinhai Ye, Qinhong Xu, Youli Li, Lihong Yu, Weiying Feng, Pan Hong, Kejie Zhang
• Journal: Hematology (Amsterdam, Netherlands) (Hematology) Vol. 26 Issue 1 Pg. 956-963 (Dec 2021) ISSN: 1607-8454 [Electronic] England
• PMID: 34871524 (Publication Type: Journal Article)

Chemical References

• Steroids
• Ferritins

Topics

• Adult
• Age Factors
• Drug Resistance
• Female
• Ferritins (blood)
• Humans
• Male
• Middle Aged
• Nomograms
• Purpura, Thrombocytopenic, Idiopathic (blood, drug therapy)
• ROC Curve
• Recurrence
• Steroids (therapeutic use)