Age-specific clinical features and prognostic risk factors in pediatric ITP: A single-center retrospective cohort study of 966 cases

Objective To explore the clinical features, predictive factors for treatment efficacy, diagnostic type and relapse for pediatric immune thrombocytopenia (ITP). Method Retrospective cohort study of 966 pediatric ITP individuals (2010–2020, Children’s hospital of Chongqing medical university). Demographic data, platelet counts, triggers, treatments, bleeding scores, and outcomes were collected. Analysis included Chi-square test, Cox regression (efficacy), Logistic regression (diagnostic type and relapse ) and ROC curves. Results There are significant differences in the trigger factors(p < 0.001), bleeding score (p < 0.001), diagnostic type(p = 0.003), and treatment efficacy(p < 0.001) of pediatric ITP among various stages of childhood. Risk factors for poor efficacy: older age (toddlerhood to adolescence: HR = 3.02–6.31, p < 0.007) and viral infection with vaccination triggers (HR = 3.89, P = 0.028). Protective factors for favorable diagnostic type: infancy/toddlerhood (OR = 0.23–0.38,p ≤ 0.029) and lower bleeding scores (OR = 0.33–0.38,p ≤ 0.024). Relapse risks: older age (OR = 4.31–7.57,p ≤ 0.007),platelet counts ≥ 10 ×10⁹/L(OR = 1.94, p = 0.017) and high bleeding scores (OR = 4.33–8.41, p ≤ 0.002). Glucocorticoid (GC) tapering time and IVIG status had no impact (p > 0.05). Conclusion Pediatric ITP exhibits age-specific clinical/prognostic patterns. Age,bleeding score, platelet counts and dual triggers are independent prognostic factors. Short-course GC therapy is recommended.