Hospitalization and thromboembolic outcomes in patients with immune thrombocytopenic purpura and celiac disease: A retrospective cohort study

Abstract Background: Immune Thrombocytopenic Purpura (ITP) is an autoimmune condition characterized by isolated thrombocytopenia, with known associations to other autoimmune diseases, including celiac disease (CD). While CD is traditionally linked to bleeding tendencies due to malabsorption and vitamin deficiencies, emerging evidence suggests it may also be associated with prothrombotic states. However, data on the clinical impact of coexisting CD in hospitalized ITP patients remain limited. This study aimed to evaluate the effect of concomitant CD on thromboembolic risk, in-hospital mortality, length of stay (LOS), adults with ITP. Methods: We conducted a retrospective cohort study of all admitted patients (aged ≥18 years) from 2018 to 2021 who had primary or secondary diagnosis of ITP (ICD-10: D69.3). Patient records were drawn from the Healthcare Cost and Utilization Project all-payer inpatient healthcare database. The cohort was stratified based on the presence (cases) or absence (control) of a coexisting CD diagnosis (new or old; ICD-10 K90.0). Primary outcomes were incidence of arterial and venous thromboembolic events, in-hospital mortality, length of stay (LOS), and inflation-adjusted total hospitalization costs. Secondary outcomes included thrombotic complications blood product transfusions, splenectomy rates, and discharge disposition. Linear and univariate binary regression was done to identify unadjusted odds ratio. Multivariable logistic (mortality, thromboembolic events) and linear (LOS, costs) regression analyses were used for adjusting for demographics, comorbidities, and disease severity markers. All analyses were done using SPSS v26. α was set to 0.05 for all analyses. Results: From the national cohort of 49,338 hospitalized ITP patients (representing 246,690 weighted cases), we identified a clinically significant subpopulation with comorbid CD consisting of 615 weighted CD cases (0.2% of all ITP cases). Patients with CD were significantly younger than those without (mean age 56.5 vs. 61.3 years; p<0.001). Females constituted 132,330 (56.6%) of the study population.Thromboembolism: CD was associated with 69% higher adjusted odds (aOR 1.69, 95% CI 1.13–2.54; p=0.010). Non-significant associations included protective effects of obesity (aOR 0.83), heart failure (aOR 0.70), and liver disease (aOR 0.74).Mortality: No significant association with CD (aOR 1.31, 95% CI 0.78–2.19; p=0.301). Increasing age (aOR 1.03/year; p<0.001) and hypertension (aOR 1.48; p<0.001) showed significant mortality risk, while heart failure was protective (aOR 0.69; p=0.02).LOS: No difference (6.8 vs. 6.5 days; p=0.642)Comorbidities: Hypertension (28.7%; p=0.82), diabetes (29.3%; p=0.74), and obesity (18.1%; p=0.91) did not differ between groups after adjustment.Conclusion: In this cohort of hospitalized patients with ITP, coexisting CD was independently associated with a significantly increased risk of thromboembolic events, despite adjustment for age, sex, comorbidities, and socioeconomic factors. However, CD was not associated with increased in-hospital mortality, or prolonged hospital stay. These findings suggest celiac comorbidity may identify an ITP subpopulation with heightened thrombotic susceptibility, though mechanistic pathways require further investigation. Clinicians should consider thromboembolic risk assessment in this subgroup to guide individualized management.