Burden of immune thrombocytopenia in hospitalized myeloid leukemia patients: Analysis from a national inpatient database

Abstract Background Chronic lymphocytic leukemia (CLL) and Acute lymphocytic leukemia are the most commonly known leukemias that cause immune thrombocytopenic purpura (ITP). However, there is limited data regarding other myeloid leukemias that cause ITP. Method We conducted a retrospective analysis of the 2022 National Inpatient Sample (NIS) database using STATA 18 to identify hospitalizations for myeloid leukemia with ITP. We used a t-test to compare mean age, length of stay, and total charges between ITP patients with and without myeloid leukemia. We performed a chi-square test to assess epidemiological disparities between the groups. Results In 2022, there were 315,277 hospitalizations for ITP and 21,723 for AML. A total of 4,954 cases of myeloid leukemia with ITP were identified, with 81.5% in AML and 13.1% in CML. Acute myeloid leukemia with ITP subsets included 63.5% myeloblastic, 12.7% myelomonocytic, 2.3% acute promyelocytic, 1.8% monocytic, 0.3% megakaryoblast, and 0.2% erythroid leukemia. The t-test indicated a mean age of 64 years for myeloid leukemia with ITP compared to 63 years for ITP without leukemia with a p-value of 0.01. There was no significant difference between sexes (p=0.32). All-cause mortality was higher in AML with ITP (11.39%) compared to ITP without AML (7.4%). Multivariate logistic regression showed higher odds for epistaxis (OR 4.2, 95% CI 3.6-4.8, p<0.01), non-traumatic intracranial bleed (OR 4.1, 95% CI 3.6-4.8, p<0.00), platelet transfusion (OR 5.4,95% CI 5.07-5.9, p<0.03), and blood transfusion (OR 2.59, 95% CI 2.4-2.7, p<0.00). The length of stay was longer for ITP with AML (M=10.5 vs. 8 days, t=17.32, p<0.00), along with increased charges ($164597 vs. 126387, t=11.75, p<0.02). Conclusion The analyses identified the distribution of ITP in various myeloid leukemias. Myeloid leukemia patients with ITP were associated with high all-cause mortality, total charges, and more extended hospitalization and complications. This also warrants further research to identify if there is refractoriness to standard treatment.