Abstract 4139492: Impact Of Valvular Heart Diseases On In Hospital Outcomes Of Patients With Immune Thrombocytopenic Purpura - A Nationwide Analysis

Background: There are multiple studies showing high prevalence of valvular heart diseases(VHD) in patients with Immune Thrombocytopenic Purpura(ITP) and the need for prompt pre-operative treatment while attempting surgical repair of valves. A reciprocal occurrence of high valvular complications in suboptimally treated ITP were also reported in literature. This could be multifactorial and can be attributed to increased platelet destruction from shear stress and turbulent flow from stenotic or regurgitant valves, increased platelet reactivity, acquired platelet dysfunction and dilutional effect. In this study, we tried to analyze the in-hospital outcomes of ITP in patients who have VHD. Methods: We queried the National inpatient sample 2016-2020 using ICD-10 codes to identify VHD hospitalizations(stenotic and regurgitant mitral, tricuspid, aortic and pulmonary valves). This population was stratified with the prevalence of ITP. Complication rates for bleeding, sepsis, pulmonary hypertension, infective endocarditis, acute embolic stroke and arrhythmia were compared in these cohorts using chi-square test. Multivariate regression analysis was further performed to study the impact of VHD on mortality, length of stay and total hospitalization charges in the subpopulation of ITP hospitalizations after adjusting for relevant confounders. Results: We identified 8,279,973 VHD hospitalizations with a mean age of 73.58 without ITP and 73.72 with ITP, of which 48.6 % were females. The prevalence of ITP in this subpopulation was 0.27%(N = 22, 995). As compared to ITP hospitalizations without VHD, hospitalizations with VHD had a statistically significant higher occurrence of epistaxis, hemoptysis, hematuria, gastrointestinal bleed, intracranial bleed, sepsis, pulmonary hypertension, arrhythmia and infective endocarditis(Table 1). In the subgroup of hospitalizations with ITP, multivariate regression analysis revealed higher odds of mortality, increased length of stay and higher hospital charges with VHD than those without VHD.(Table 2) Conclusion: Valvular heart diseases have significant impact on the in hospital outcomes of patients admitted with ITP. Considering the possibility of reciprocal influence, there is a further scope for prospective studies to establish bidirectional association which can give way to promising options to improve outcomes in patients with valvular heart disease who develop ITP and can also aid in pre-operative risk stratification for valvular surgeries