Clinical Characteristics and Predictors of Chronicity in Children With Immune Thrombocytopenia

Introduction Immune thrombocytopenia (ITP) in children is typically self-limited; however, a subset progresses to chronic disease. Identifying early predictors of chronic evolution remains clinically important to improve risk stratification and management strategies. Methods We conducted a retrospective cohort study of 47 children aged 1-14 years diagnosed with primary ITP at a tertiary care center between 2020 and 2025. Baseline demographic, clinical, laboratory, and treatment data were extracted from electronic records. Early treatment response was categorized as complete, partial, transient, or no response. Associations with chronic disease were evaluated using non-parametric testing and exact categorical analyses. Multivariable logistic regression was performed to identify independent predictors of chronicity. Results Chronic ITP developed in 12 of 47 patients (25.5%). The early response category was strongly associated with chronic evolution (p < 0.001). Among chronic patients, 91.7% exhibited a transient response pattern, and none achieved a sustained complete response. Baseline platelet count differed significantly between complete and non-complete responders (p = 0.002) and showed a near-significant association with chronicity in multivariable analysis (adjusted OR 1.057 per 1 ×103/µL increase; 95% CI 0.997-1.120; p = 0.065). Age at diagnosis and autoimmune markers were not independently associated with chronic disease. The whole exome sequencing category demonstrated a significant association with chronicity (p < 0.001), though testing was clinically selected. Conclusion Early treatment response dynamics strongly discriminate long-term disease trajectory in pediatric ITP. Transient response is highly predictive of chronic evolution, whereas sustained complete response appears protective. Baseline platelet count may contribute to risk stratification. These findings support incorporating early response patterns into prognostic assessment models for pediatric ITP.