淋巴细胞绝对值对成人原发免疫性血小板减少症患者诊断后6个月内合并感染的预测意义

OBJECTIVE: To explore incidence, risk factors and prognosis of the first 6 months infectious events in adults with newly diagnosed primary immune thrombocytopenia (ITP), and evaluate the value of initial absolute lymphocyte count (ALC) in predicting infection. METHODS: The initial clinical records and infectious events during 6 months of 217 adult with newly diagnosed ITP were retrospectively analyzed. Statistical methods were used to analyze risk factors of the 6 months infections in adults ITP, the prediction of ALC in risk of infection, and the association of ALC and prognosis. RESULTS: Infection rate of ITP patients accepting therapy within 6 months after the initial diagnosis was 13.8% (30/217), and infection rate of patients≥60 years of age 25% (14/56). Multivariate unconditioned Logistic analysis showed that gender and ALC were independent risk factors for the 6 months infection of ITP patients (P< 0.05, 95%CI 1.150–7.298, OR 2.722 and P<0.001, 95% CI 6.802–80.749, OR 23.436). Cutoff value of ALC was 1.225×10(9)/L, sensitivity and specificity of its value were 0.866 and 0.700 respectively. Infection rate of ALC>1.225×10(9)/L in adult ITP was lower than of ALC≤1.225×10(9)/L (5.3% vs 45.7%, χ(2)=49.151, P< 0.001). Furthermore, persistent recovery and the 1-year mortality rate after diagnosis had no difference among patients of different ALC (28.0% vs 26.0%, χ(2)=0.071, P>0.05, and 98.6% vs 97.8%, χ(2)=0.095, P> 0.05). There were no significant differences in persistent recovery in patients with and without infection (30.0% vs 27.3%, χ(2)=0.096,P>0.05). The 1-year mortality rate after diagnosis was significantly lower in those patients who developed an infection (93.3% vs 99.3%, χ(2)=4.607, P<0.05). CONCLUSION: Initial ALC was an independent risk factor of 6 months infection in adult ITP. It could be a predictive index of infection within 6 months of the initial diagnosis in ITP patients. Infection as an important factor affected the survival of ITP patients.