Age-specific clinical features and prognostic risk factors in pediatric ITP: A single-center retrospective cohort study of 966 cases

Age-specific clinical features and prognostic risk factors in pediatric ITP: A single-center retrospective cohort study of 966 cases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Age-specific clinical features and prognostic risk factors in pediatric ITP: A single-center retrospective cohort study of 966 cases Li Zhang, Jiebin Qin, Lan Huang, Xianhao Wen, Haiyan Liu, Yuxia Guo, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8497619/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To explore the clinical features, predictive factors for treatment efficacy, diagnostic type and relapse for pediatric immune thrombocytopenia (ITP). Method Retrospective cohort study of 966 pediatric ITP individuals (2010–2020, Children’s hospital of Chongqing medical university). Demographic data, platelet counts, triggers, treatments, bleeding scores, and outcomes were collected. Analysis included Chi-square test, Cox regression (efficacy), Logistic regression (diagnostic type and relapse ) and ROC curves. Results There are significant differences in the trigger factors(p < 0.001), bleeding score (p < 0.001), diagnostic type(p = 0.003), and treatment efficacy(p < 0.001) of pediatric ITP among various stages of childhood. Risk factors for poor efficacy: older age (toddlerhood to adolescence: HR = 3.02–6.31, p < 0.007) and viral infection with vaccination triggers (HR = 3.89, P = 0.028). Protective factors for favorable diagnostic type: infancy/toddlerhood (OR = 0.23–0.38,p ≤ 0.029) and lower bleeding scores (OR = 0.33–0.38,p ≤ 0.024). Relapse risks: older age (OR = 4.31–7.57,p ≤ 0.007),platelet counts ≥ 10 ×10⁹/L(OR = 1.94, p = 0.017) and high bleeding scores (OR = 4.33–8.41, p ≤ 0.002). Glucocorticoid (GC) tapering time and IVIG status had no impact (p > 0.05). Conclusion Pediatric ITP exhibits age-specific clinical/prognostic patterns. Age,bleeding score, platelet counts and dual triggers are independent prognostic factors. Short-course GC therapy is recommended. pediatric immune thrombocytopenia (ITP) age-specific clinical feature prognosis risk factors retrospective cohort study Figures Figure 1 Figure 2 Figure 3 1. Introduction Immune thrombocytopenia (ITP) is a common bleeding disorder characteristic by platelet (PLT) count below normal value (< 100×10 9 /L)[ 1 ]. According to statistics, the incidence rate in children is approximately 1.9–6.4 per 100000 person-years[ 2 ]. The pathogenesis is closely associated with platelet destruction mediated by autoantibodies against platelets and impaired platelet production by megakaryocytes induced by immune dysregulation[ 3 ]. Most children with ITP often have a history of viral infection or vaccination 2 to 4 weeks prior to disease onset[ 4 ]. Children ITP generally present as acute disorder. The clinical manifestation is mainly dominated by mucocutaneous bleeding, while a small number of severely ITP children present at fatal risk of serious visceral hemorrhage and intracranial hemorrhage[ 5 ]. Children ITP is typically self-limiting disorder. The purpose of therapy is to rapidly increase the level of PLT for control the bleeding[ 6 ]. glucocorticoid (GC) and intravenous immunoglobulin (IVIG) are standard first-line treatment options for patients with ITP[ 7 ].Although ITP is often self-limiting, about 10%-20% of those present worse treatment response, which progresses to chronic ITP, and a subset of these patients further develops refractory ITP[ 8 ]. The chronic and refractory ITP extremely affect life quality of individuals and their caregivers, and also impose a heavy economic burden on their families[ 9 ]. The side effects of long-term GC therapy are various with age. Infants and young children are prone to growth retardation and osteoporosis[ 10 – 12 ], preschool children may develop metabolic disorder (such as obesity and glucose abnormality) and decreased immunity[ 13 ]; and adolescents may experience induced psychotic disorder[ 14 ]. Therefore, the early identification of risk factors influencing the prognosis of pediatric ITP is important for improving long-term outcomes. Currently, most clinical studies on pediatric ITP are small sample and single center investigations, lacking large sample studies with systematic and long-term follow-up. Therefore, we classified pediatric ITP patients by age into infancy, toddlerhood, preschool age, school age and adolescence, with the majority of patients followed up more than 1 year. The purpose of this study was to clarify clinical characteristics and factors influencing prognosis across different developmental stages in children ITP patients, and to provide a more optimal basis for clinical risk stratification, further optimize treatment regimens, reduce adverse drug reactions, and alleviate the long-term burden on patients and their families. 2. Methods Study design and participants This retrospective cohort study included ITP patients hospitalized (2010–2020) at hematological oncology department in Children’s hospital of Chongqing medical university. Informed consent was obtained from patient’s legal guardians of every participate prior to study enrollment. This study was approved by clinical Ethics Committee of the Children’s hospital of Chongqing Medical University (Approval Number: 2021 Ethical Review (Research) No. 455)) and conducted in accordance with the Declaration of Helsinki. This study was registered in the Chinese Clinical Trial Registry with the trial number ChiCTR2200055472 on 10 January 2022. Inclusion and exclusion criteria The inclusion criteria were: (1) Primary ITP patients diagnosed from 2010 to 2020; (2) hospitalized at our center < 18 years. Of 3716 patients screened ,966 were finally included after excluding: (1) loss to follow-up in this center (n = 2169); (2) GC therapy at other hospital (n = 131); (3) no taking oral GC therapy (n = 33); (4) with other diseases (n = 305); (5) missing GC taper time (n = 121). A patient selection flowchart was shown in Fig. 1. Baseline information and treatment effectiveness were collected including age, gender, initial PLT count, IVIG therapy status, GC tapering time, bleeding score, triggering factors and follow-up duration, therapeutic effect, diagnosis type and relapse status[ 11 ]. Definition and outcomes Complete response (CR): PLT counts ≥ 100×10 9 /L and no bleeding. Partial response (PR): PLT counts of 30–100×10 9 /L, with at least a twofold increase from that baseline count and no bleeding. Persistent non-response: PLT counts < 30×10 9 /L post-treatment or increase < twice the baseline or presence of bleeding[ 15 ]. Relapse: after a therapeutic response is achieved, the PLT counts drops < 30×10 9 /L, fails to increase to at least twice the baseline level, or bleeding [ 16 ]. Therapy effective: achievement of PR or CR with no relapse during follow-up. Ineffective: persistent non-response or post-response relapse. ITP types were divided by illness duration from diagnosis to remission: newly diagnosed ITP ( 1 year)[ 15 ]. Initial PLT counts is defined as the PLT counts measured prior to first-line therapy administration. Bleeding symptoms grading (scores 1, 2, 3, 5 and 8) derived from the 2019 Chinese standard for diagnosis and treatment of childhood primary ITP[ 17 ]. Statistical analysis SPSS 29.0 and R 4.4.1 were used for statistical analyses. Descriptive statistics: non-normally distributed continuous variables are presented as median (IQR), categorical data as frequencies and percentages (%). Regression analyses: Cox proportional hazards, ordinal logistic, and binary logistic regression were performed to assess factors influencing treatment efficacy, ITP diagnosis type and relapse. Step wise variable selection based on Akaike information criterion (AIC). ROC curves analysis was performed to valuate the discriminative ability of key predictors for outcomes with area under the curve (AUC) and 95% CI. A two-tailed p < 0.05 was considered statistically significant. 3. Results 3.1 Clinical characteristics of ITP patients A total of 966 ITP patients were enrolled including 562 males (58.2%) and 404 females (41.8%). Age distribution: infancy (303, 31.4%), toddlerhood (230, 23.8%), preschool age (194, 20.1%), school age (202, 20.9%) and adolescence (37, 3.8%). 606 cases (62.7%) had a PLT counts < 10 ×10⁹/L, 633 cases (65.5%) did not receive IVIG, 123 cases (12.7%) had GC tapered within one week, and 702 cases (72.7%) had no obvious triggering factors. Bleeding score distribution: 1 (384, 39.8%), 2 (466, 48.2%), 3(39, 4.0%), 5 (42, 4.3%) and 8 (35, 3.6%). ITP type: newly diagnosed ITP (849, 87.9%), persistent ITP (76,7.9%) and chronic ITP (41,4.2%). Treatment efficacy: achieved effective outcomes (854,88.4%) and ineffective (112, 11.6%), and relapse (61, 6.3%). Median follow-up duration was 110 days (IQR: 36–680 days), shown in Table 1 . Notably, significantly difference exists in trigger factors, bleeding scores, diagnostic type and therapeutic outcomes across various age stages, as shown in Table S1 . Table 1 Demographics and clinical characteristics of patients with ITP. Category Total Ineffective Effective Gender 966 112 (11.6%) 854 (88.4%) male 562 (58.2%) 71 (12.6%) 491 (87.4%) female 404 (41.8%) 41 (10.1%) 363 (89.9%) Age group infancy 303(31.4%) 15 (5.0%) 288 (95.0%) toddlerhood 230(23.8%) 26 (11.3%) 204 (88.7%) preschool age 194(20.1%) 24 (12.4%) 170 (87.6%) school age 202(20.9%) 43 (21.3%) 159 (78.7%) adolescence 37(3.8%) 4 (10.8%) 33 (89.2%) Initial PLT counts PLT counts < 10 ×10⁹/L 606(62.7%) 64 (10.6%) 542 (89.4%) PLT counts ≥ 10 ×10⁹/L 360 (34.5%) 48 (13.3%) 312 (86.7%) IVIG status no IVIG 633(65.5%) 68 (10.7%) 565 (89.3%) IVIG administrated 333(34.5%) 44 (13.2%) 289 (86.8%) GC taper time ≤ 7 days 123(12.7%) 9 (7.3%) 114 (92.7%) > 7days 843(87.3%) 103 (12.2%) 740 (87.8%) Trigger factors no obvious factor 702 (72.7%) 89 (12.7%) 613 (87.3%) vaccination 136 (14.1%) 10 (7.4%) 126 (92.6%) viral infection 116 (12.0%) 10 (8.6%) 106 (91.4%) vaccination + viral infection 12 (1.2%) 3 (25.0%) 9 (75.5%) Bleeding score score 1 384(39.8%) 37 (9.6%) 347(90.4%) score 2 466 (48.2%) 45 (9.7%) 421 (90.3%) score 3 39 (4.0%) 7 (17.9%) 32 (82.1%) score 5 42 (4.3%) 13 (31.0%) 29 (69.0%) score 8 35 (3.6%) 10 (28.6%) 25 (71.4%) Diagnostic type newly diagnosed ITP 849 (87.9%) 48 (5.7%) 801 (94.3%) persistent ITP 76 (7.9%) 36 (47.4%) 40 (52.6%) chronic ITP 41 (4.2%) 28 (68.3%) 13 (31.7%) Efficacy 966 Primary failure 51 (5.3%) Relapse after response 61 (6.3%) PR 120 (12.4%) CR 734 (76.0%) Abbreviations : Platelet:PLT, Intravenous immunoglobulin: IVIG, Glucocorticoid:GC, Complete response: CR, Partial response: (PR). 3.2 Cox analysis of efficacy. Cox analysis was performed to identify factors influencing the treatment efficacy of pediatric ITP. Gender, initial PLT counts, and GC tapering time weren’t significantly associated with treatment efficacy. Age, Initial IVIG administration status, trigger factors, and bleeding scores were significantly associated with treatment efficacy. Further multivariate analysis results revealed that the risk of treatment ineffectiveness was increased in toddlerhood (HR = 3.02, p = 0.001, 95% CI: 1.56–5.87), preschool age (HR = 2.55,p = 0.007, 95% CI: 1.29–5.03), school age (HR = 6.22, p < 0.001, 95% CI: 3.29–11.76) and adolescence (HR = 6.31,p = 0.002, 95% CI: 1.99-20.00) compared with infancy, indicating that a significant decline in first-line treatment efficacy with increasing age. Compared with ITP patients without triggering factors, those with both vaccination and viral infection had a 3.89 times increased risk of treatment ineffectiveness (HR = 3.89, p = 0.028, 95% CI: 1.16–13.02). Age and both vaccination history and viral infection as antecedent events of onset are independent risk factors for poor treatment efficacy in pediatric ITP, as shown in Table 2 . ROC curve analysis showed that AUC of age and triggering factors for predicting treatment efficacy in pediatric ITP was 0.642 and 0.535, respectively, as shown in Fig. 2 . Table 2 Cox analysis results of efficacy. Univariate analysis Multivariate analysis Characteristics Total Hazard ratio (95% CI) P value Hazard ratio (95% CI) P value Gender male 562 (58.2%) Reference female 404 (41.8%) 0.81 (0.55,1.20) 0.29 Age group 0.001 < 0.001 infancy 303 (31.4%) Reference Reference toddlerhood 230 (23.8%) 2.96 (1.56,5.60) < 0.001 3.02 (1.56,5.87) 0.001 preschool age 194 (20.1%) 2.65 (1.39,5.06) 0.003 2.55 (1.29,5.03) 0.007 school age 202 (20.9%) 6.69 (3.69, 12.12) < 0.001 6.22 (3.29,11.76) < 0.001 adolescence 37 (3.8%) 6.11 (1.99,18.72) 0.002 6.31 (1.99, 20.00) 0.002 Initial PLT counts PLT counts < 10 ×10⁹/L 606 (62.7%) reference PLT counts ≥ 10 ×10⁹/L 360 (34.5%) 0.975 (0.67,1.42) 0.90 IVIG status no IVIG 633 (65.5%) Reference reference IVIG administrated 333 (34.5%) 1.51 (1.03,2.21) 0.03 1.34 (0.900,2.007) 0.148 GC taper time ≤ 7 days 123 (12.3%) Reference > 7 days 843 (87.3%) 1.52 (0.77,3.01) 0.23 Trigger factors no obvious cause 702 (72.7%) reference 0.02 reference 0.06 vaccination 136 (14.1%) 0.50 (0.26,0.96) 0.04 0.96 (0.48,1.91) 0.899 viral infection 116 (12%) 0.506 (0.26,0.97) 0.04 0.62 (0.32,1.20) 0.156 vaccination + viral infection 12 (1.2%) 2.10 (0.66,6.65) 0.21 3.89 (1.16,13.02) 0.028 Bleeding score score 1 384 (39.8%) reference 0.008 reference 0.658 score 2 466 (48.2%) 0.81 (0.52,1.24) 0.34 0.85 (0.54,1.33) 0.472 score 3 39 (4.0%) 1.68 (0.75,3.8) 0.21 1.10 (0.48,2.50) 0.825 score 5 42 (4.3%) 2.11 (1.12,3.98) 0.02 1.31 (0.67,2.56) 0.424 score 8 35 (3.6%) 1.82 (0.90,3.67) 0.10 1.26 (0.60,2.66) 0.546 Abbreviations : Platelet:PLT, Intravenous immunoglobulin:IVIG, Glucocorticoid:GC. 3.3 Analysis of long-term prognosis diagnostic type. Subsequently, we evaluated the factors influencing diagnostic classification. Univariate analysis revealed that no significant associations between gender, initial PLT counts, initial IVIG administration status, GC tapering time and triggering factors and diagnostic classification of pediatric ITP. Age and bleeding score was significantly associated with ITP type. Further multivariate analysis results revealed that the risk of progression to persistent or chronic ITP in infancy and toddlerhood was 0.23 (p = 0.001, 95% CI: 0.09–0.55) and 0.38 (p = 0.029, 95% CI: 0.16–0.91) times that of adolescence, respectively. The risk of progressing to persistent of chronic ITP with bleeding score 1 or 2 was 0.33 (p = 0.01, 95% CI: 0.14–0.77) and 0.38 (p = 0.024, 95% CI: 0.17–0.88) times that of those with a bleeding score 8, respectively. Older age and higher bleeding score were independent risk factors for persistent and chronic ITP, as shown in Table 3 . A significant difference in the distribution of diagnostic classification between patients who achieved a response within 28 days after treatment and those who achieved response after 28 days, as shown in Table S2 . Additionally, we explore the correlation between initial PLT counts and bleeding score. Spearman correlation analysis result showed that initial PLT counts has a negative correlation with bleeding score, but it was not statistically significant,as shown in Figure S1 . Table 3 Logistic analysis results of long-term prognosis Diagnostic subtype. Univariate analysis Multivariate analysis Characteristics Total Odds ratio (95% CI) p value Odds ratio (95% CI) p value Gender male 562 (58.2%) 0.93 (0.63,1.37) 0.696 female 404 (41.8%) Reference Age group infancy 303 (31.4%) 0.23 (0.09,0.53) < 0.001 0.23 (0.09,0.55) 0.001 toddlerhood 230 (23.8%) 0.36 (0.15,0.84) < 0.001 0.38 (0.16,0.91) 0.029 preschool age 194 (20.1%) 0.52 (0.23,1.21) 0.018 0.51 (0.22,1.18) 0.115 school age 202 (20.9%) 0.63 (0.28,1.44) 0.128 0.61 (0.26,1.39) 0.240 adolescence 37 (3.8%) Reference Reference Initial PLT counts PLT counts < 10 ×10⁹/L 606 (62.7%) 0.91 (0.61,1.35) 0.646 PLT counts ≥ 10 ×10⁹/L 360 (34.5%) Reference IVIG status no IVIG 633 (65.5%) 1.11 (0.74,1.68) 0.607 IVIG administrated 333 (34.5%) Reference GC taper time ≤ 7 days 123 (12.3%) 0.69 (0.36,0.76) 0.265 > 7 days 843 (87.3%) Reference Trigger factors no obvious cause 702 (72.7%) 1.79 (0.22,14.35) 0.583 vaccination 136 (14.1%) 0.72 (0.08,6.39) 0.756 viral infection 116 (12%) 1.32 (0.15,11.36) 0.801 vaccination + viral infection 12 (1.2%) Reference Bleeding score score 1 384 (39.8%) 0.38 (0.16,0.87) 0.023 0.33 (0.14,0.77) 0.010 score 2 466 (48.2%) 0.40 (0.17,0.91) 0.030 0.38 (0.17,0.88) 0.024 score 3 39 (4.0%) 0.61 (0.15,1.93) 0.398 0.45 (0.14,1.48) 0.192 score 5 42 (4.3%) 1.31 (0.47,3.63) 0.600 0.90 (0.32,2.53) 0.837 Score 8 35 (3.6%) Reference Abbreviations : Platelet:PLT, Intravenous immunoglobulin: IVIG, Glucocorticoid:GC. 3.4 Clinical characteristics and logistic analysis of relapse risk factors in ITP patients. Among this cohort, 61 cases (57.4% male) relapsed after achieving treatment efficacy. Relapse mainly occurred post-infancy, with the highest prevalence in school age (36.1%) and was more frequent in patients who received IVIG therapy at initial diagnosis (67.2%) and those with chronic ITP (41%), as shown in Figure S2 . Subsequently, Univariate analysis results showed that gender, initial IVIG status, GC tapering time, and triggering factors were not significantly associated with relapse. While, age, initial PLT counts and bleeding score were significantly correlated with relapse. Further multivariate analysis results revealed that compared with infancy, the risk of relapse after response in toddlerhood, preschool age, and school age was increased by 3.31 (p = 0.009, 95% CI: 1.49–12.49), 4.78 (p < 0.001, 95% CI: 2.04–16.33) and 6.57 (p < 0.001, 95% CI: 2.72–21.03) times, respectively. Patients with an initial PLT counts ≥ 10 ×10⁹/L at diagnosis had a 1.94 time (p = 0.017, 95% CI: 1.12–3.35) increased risk of relapse compared with those with an initial PLT counts < 10×10⁹/L at diagnosis. Additionally, compared with a bleeding score 1, the relapse risk was increased by 3.33 (p = 0.002, 95% CI:1.68–11.14) and 7.41 (p < 0.001, 95% CI: 3.09–22.92) times in patients with bleeding score 5 and 8, respectively. These results indicated that older age, higher initial PLT counts and bleeding score were independent risk factors for relapse of pediatric ITP, as shown in Table 4 . The ROC curve analysis showed that AUCs for predicting relapse were 0.663 (age), 0.571 (initial PLT counts) and 0.632 (bleeding score), as shown in Fig. 3 . Table 4 Logistic analysis results of relapse. Univariate analysis Multivariate analysis Characteristics Total Odds ratio (95% CI) p value Odds ratio (95% CI) p value Gender 915 male 526 (57.5%) Reference female 389 (42.5%) 1.005 (0.59,1.70) 0.986 Age group infancy 293 (32.0%) Reference Reference toddlerhood 218 (23.8%) 3.96 (1.40, 11.15) 0.009 4.31 (1.49,12.49) 0.007 preschool age 188 (20.5%) 6.10 (2.22,16.73) < 0.001 5.78 (2.04,16.33) < 0.001 school age 181 (19.8%) 7.97 (2.96,21.45) < 0.001 7.57 (2.72,21.03) < 0.001 adolescence 35 (3.8%) 3.49 (0.65,18.71) 0.144 3.73 (0.67,20.83) 0.134 Initial PLT counts PLT counts < 10 ×10⁹/L 572 (62.5%) Reference Reference PLT counts ≥ 10 ×10⁹/L 343 (37.5%) 1.80 (1.07,3.02) 0.028 1.94 (1.12,3.35) 0.017 Initial IVIG administration no IVIG 606 (66.2%) Reference IVIG administrated 309 (33.8%) 0.95 (0.55,1.66) 0.866 GC taper time ≤ 7 days 118 (12.9%) Reference > 7 days 797 (87.1%) 2.20 (0.78,6.17) 0.136 Trigger factors no obvious cause 661 (72.2%) Reference vaccination 132 (14.4%) 0.61 (0.26,1.45) 0.263 viral infection 111 (12.1%) 0.60 (0.23,1.55) 0.801 vaccination + viral infection 11 (1.2%) 2.84 (0.60,13.51) 0.190 Bleeding score score 1 364 (39.8%) Reference Reference score 2 444 (48.5%) 1.12 (0.59,2.12) 0.740 1.29 (0.67,2.47) 0.446 score 3 37 (4.0%) 3.19 (1.10,9.21) 0.032 2.76 (0.93,8.18) 0.067 score 5 37 (4.0%) 5.63 (2.24,14.16) < 0.001 4.33 (1.68,11.14) 0.002 score 8 33 (3.6%) 6.53 (2.57,16.61) < 0.001 8.41 (3.09,22.92) < 0.001 Abbreviations : Platelet:PLT, Intravenous immunoglobulin: IVIG, Glucocorticoid:GC. Discussion This study revealed that age is an independent risk factor for treatment efficacy, and age and bleeding score were independent risk factors for diagnostic ITP type. Additionally, age, bleeding score and initial PLT counts ≥ 10×10⁹/L at diagnosis were independent factors for relapsed. Furthermore, we found that no significant associations between either GC tapering within 1 week or beyond 1 week, or IVIG administration status and treatment efficacy, diagnostic type or relapsed of pediatric ITP. In this study, we found pediatric ITP has a higher prevalence in infancy, with a male predominance, which is consistent with previous study[ 18 ]. Age presented as a consistent predictive factor for treatment efficacy, diagnosis type and relapse risk in pediatric ITP. Specifically, with increasing age, the risk of poor treatment efficacy, relapse and progression to chronic ITP was significantly elevated, which was similar to prior study[ 19 ]. The development of pediatric immunity system has an age distribution characteristic[ 20 ]. The immune system is immature in infancy, and immune tolerance possesses strong plasticity[ 21 ]. Consequently, infants with ITP are more likely to achieve treatment efficacy through spontaneous immune regulation, indicating favorable response to first-line therapy and a lower propensity to progress to persistent and chronic ITP. In this study, we identified that bleeding score is a common independent risk factor for both diagnosis type and the risk of relapse in pediatric ITP, indicating that the higher bleeding score was significantly associated with an increased risk of relapse and progression to persistent and chronic ITP. However, previous studies have reported no significant association between bleeding score and diagnosis type of pediatric ITP[ 22 ], which may be related with the sample size and the heterogeneity of the study population. A higher bleeding score essentially reflects a pathological state characterized by more severe vascular endothelial injury, abnormal platelet function or intense immune attack[ 23 ]. Persistent abnormal immune system is less likely to recover, thereby leading to the relapsed and chronic ITP[ 24 ]. Moreover, we found a negative correlation between initial PLT counts and bleeding score, but without statistical significance, consistent with previous report[ 22 ]. This further suggests that only PLT counts cannot fully explain the variations in bleeding scores. In this study, we found that initial PLT counts is also an independent risk to predict the relapse of children ITP. With increasing initial PLT counts, the risk of relapse of ITP is higher. A relatively higher PLT counts usually indicates a relatively mild degree of platelet destruction[ 25 ], while it doesn’t rule out the persistent abnormal activation of immune system, which may be a potentially crucial etiological factor for relapse of pediatric ITP. This finding suggests that a relatively higher initial PLT counts at diagnosis in pediatric ITP is not an indicator of favorable prognosis, but rather a potential signal of persistent immune activation and increased relapse risk in clinical practice. Additionally, we also found that individuals with both a vaccination and viral infection history had a significantly increased risk of treatment failure, compared with patients without identifiable triggers. Conversely, having only vaccination history or only viral infection did not affect the treatment efficacy in pediatric ITP, indicating that dual immune stimulation exacerbates immune mediated platelet destruction. Notably, we found that neither GC tapering within 1 week nor beyond 1 week, nor IVIG administration status, had a significant impact on treatment efficacy, diagnostic type and relapsed of pediatric ITP. These findings indicate that prolonging GC course or IVIG administrated fails to improve treatment efficacy or reduce the risk of relapse. Both GC and IVIG act by inhibiting immune activation-mediated platelet destruction to increase platelet counts in short term[ 26 ], and extending the duration of GC use or adding IVIG doesn’t enhance treatment efficacy or long-term prognosis of pediatric ITP. Conversely, prolonged GC administration or additional IVIG use increases the risk of adverse effects and imposes a greater economic burden on patients’ families[ 13 ]. Therefore, in the absence of severe bleeding or life-threatening conditions, observation alone or short time GC therapy is recommended as the first-line approach. Declarations Acknowledgments The authors sincerely thank the patients, their guardians and all investigators involved in this study. Additionally, the authors sincerely thank the Qiankun Yang’s guidance for this design and writing of manuscript. Funding No funding supported this study. Data availability Data are available on a reasonable request from the corresponding authors. Patient consent statement Informed consent was obtained from the legal guardians of each patients before collection and use of their clinical data. Clinical Trial Number ChiCTR2200055472. Ethics statement This study was approved by clinical Ethics Committee of the Children Affiliated hospital of Chongqing Medical University (Approval Number: 2021 Ethical Review (Research) No. 455)) and conducted in accordance with the Declaration of Helsinki. Conflict of Interests disclosure statement The authors declared that no potential conflicts of interests existed in this study. CRediT authorship contribution statement Jie Yu and Li Xiao supervised the entire research process, from formulating the research design to performing data analysis and guiding the writing of the article. Li Zhang undertook the statistical analysis, interpretation of results, and wrote the initial manuscript, and completion of the revised manuscript. Jiebin Qin, Lan Huang, Xianhao Wen, Haiyan Liu, Yuxia Guo, Xingtian Xuan and Chunmei Xu assisted in collecting data extraction, cleaning and analysis. References Marini I, Zlamal J, Faul C, Holzer U, Hammer S, Pelzl L, et al. Autoantibody-mediated desialylation impairs human thrombopoiesis and platelet lifespan. Haematologica. 2021;106:196–207. https://doi.org/10.3324/haematol.2019.236117 . Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. Am J Hematol. 2010;85:174–80. https://doi.org/10.1002/ajh.21616 . 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3","display":"","copyAsset":false,"role":"figure","size":154603,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8497619/v1/7c0194acba8cbd5ff80abcb7.png"},{"id":104865823,"identity":"8b2b357b-35e1-4a22-8809-8def79869daf","added_by":"auto","created_at":"2026-03-18 06:57:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1995303,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8497619/v1/dd6d7861-0587-4fbd-8d2e-95d8dd319762.pdf"},{"id":100421490,"identity":"c6994d6d-2997-426f-8b63-3af64b6b6a83","added_by":"auto","created_at":"2026-01-16 13:33:07","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":369471,"visible":true,"origin":"","legend":"","description":"","filename":"4.Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-8497619/v1/3de7ab851d28691a8e5139cf.docx"},{"id":100399855,"identity":"5ad3164c-ca42-498b-ad6f-7d30a1a1388d","added_by":"auto","created_at":"2026-01-16 11:57:39","extension":"tif","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":782268,"visible":true,"origin":"","legend":"","description":"","filename":"Graphicalabstract.tif","url":"https://assets-eu.researchsquare.com/files/rs-8497619/v1/3e86ae60737a4a2279a6e1f5.tif"}],"financialInterests":"No competing interests reported.","formattedTitle":"Age-specific clinical features and prognostic risk factors in pediatric ITP: A single-center retrospective cohort study of 966 cases","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eImmune thrombocytopenia (ITP) is a common bleeding disorder characteristic by platelet (PLT) count below normal value (\u0026lt;\u0026thinsp;100\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to statistics, the incidence rate in children is approximately 1.9\u0026ndash;6.4 per 100000 person-years[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The pathogenesis is closely associated with platelet destruction mediated by autoantibodies against platelets and impaired platelet production by megakaryocytes induced by immune dysregulation[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Most children with ITP often have a history of viral infection or vaccination 2 to 4 weeks prior to disease onset[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Children ITP generally present as acute disorder. The clinical manifestation is mainly dominated by mucocutaneous bleeding, while a small number of severely ITP children present at fatal risk of serious visceral hemorrhage and intracranial hemorrhage[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChildren ITP is typically self-limiting disorder. The purpose of therapy is to rapidly increase the level of PLT for control the bleeding[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. glucocorticoid (GC) and intravenous immunoglobulin (IVIG) are standard first-line treatment options for patients with ITP[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].Although ITP is often self-limiting, about 10%-20% of those present worse treatment response, which progresses to chronic ITP, and a subset of these patients further develops refractory ITP[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe chronic and refractory ITP extremely affect life quality of individuals and their caregivers, and also impose a heavy economic burden on their families[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The side effects of long-term GC therapy are various with age. Infants and young children are prone to growth retardation and osteoporosis[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], preschool children may develop metabolic disorder (such as obesity and glucose abnormality) and decreased immunity[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; and adolescents may experience induced psychotic disorder[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, the early identification of risk factors influencing the prognosis of pediatric ITP is important for improving long-term outcomes.\u003c/p\u003e \u003cp\u003eCurrently, most clinical studies on pediatric ITP are small sample and single center investigations, lacking large sample studies with systematic and long-term follow-up. Therefore, we classified pediatric ITP patients by age into infancy, toddlerhood, preschool age, school age and adolescence, with the majority of patients followed up more than 1 year. The purpose of this study was to clarify clinical characteristics and factors influencing prognosis across different developmental stages in children ITP patients, and to provide a more optimal basis for clinical risk stratification, further optimize treatment regimens, reduce adverse drug reactions, and alleviate the long-term burden on patients and their families.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e \u003cb\u003eStudy design and participants\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis retrospective cohort study included ITP patients hospitalized (2010\u0026ndash;2020) at hematological oncology department in Children\u0026rsquo;s hospital of Chongqing medical university. Informed consent was obtained from patient\u0026rsquo;s legal guardians of every participate prior to study enrollment. This study was approved by clinical Ethics Committee of the Children\u0026rsquo;s hospital of Chongqing Medical University (Approval Number: 2021 Ethical Review (Research) No. 455)) and conducted in accordance with the Declaration of Helsinki. This study was registered in the Chinese Clinical Trial Registry with the trial number ChiCTR2200055472 on 10 January 2022.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe inclusion criteria were: (1) Primary ITP patients diagnosed from 2010 to 2020; (2) hospitalized at our center\u0026thinsp;\u0026lt;\u0026thinsp;18 years. Of 3716 patients screened ,966 were finally included after excluding: (1) loss to follow-up in this center (n\u0026thinsp;=\u0026thinsp;2169); (2) GC therapy at other hospital (n\u0026thinsp;=\u0026thinsp;131); (3) no taking oral GC therapy (n\u0026thinsp;=\u0026thinsp;33); (4) with other diseases (n\u0026thinsp;=\u0026thinsp;305); (5) missing GC taper time (n\u0026thinsp;=\u0026thinsp;121). A patient selection flowchart was shown in \u003cb\u003eFig.\u0026nbsp;1.\u003c/b\u003e Baseline information and treatment effectiveness were collected including age, gender, initial PLT count, IVIG therapy status, GC tapering time, bleeding score, triggering factors and follow-up duration, therapeutic effect, diagnosis type and relapse status[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eDefinition and outcomes\u003c/b\u003e \u003c/p\u003e \u003cp\u003eComplete response (CR): PLT counts\u0026thinsp;\u0026ge;\u0026thinsp;100\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L and no bleeding. Partial response (PR): PLT counts of 30\u0026ndash;100\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L, with at least a twofold increase from that baseline count and no bleeding. Persistent non-response: PLT counts\u0026thinsp;\u0026lt;\u0026thinsp;30\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L post-treatment or increase\u0026thinsp;\u0026lt;\u0026thinsp;twice the baseline or presence of bleeding[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Relapse: after a therapeutic response is achieved, the PLT counts drops\u0026thinsp;\u0026lt;\u0026thinsp;30\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L, fails to increase to at least twice the baseline level, or bleeding [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Therapy effective: achievement of PR or CR with no relapse during follow-up. Ineffective: persistent non-response or post-response relapse. ITP types were divided by illness duration from diagnosis to remission: newly diagnosed ITP (\u0026lt;\u0026thinsp;3 months), persistent ITP (3\u0026ndash;12 months) and chronic ITP(\u0026gt;\u0026thinsp;1 year)[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Initial PLT counts is defined as the PLT counts measured prior to first-line therapy administration. Bleeding symptoms grading (scores 1, 2, 3, 5 and 8) derived from the 2019 Chinese standard for diagnosis and treatment of childhood primary ITP[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSPSS 29.0 and R 4.4.1 were used for statistical analyses. Descriptive statistics: non-normally distributed continuous variables are presented as median (IQR), categorical data as frequencies and percentages (%). Regression analyses: Cox proportional hazards, ordinal logistic, and binary logistic regression were performed to assess factors influencing treatment efficacy, ITP diagnosis type and relapse. Step wise variable selection based on Akaike information criterion (AIC). ROC curves analysis was performed to valuate the discriminative ability of key predictors for outcomes with area under the curve (AUC) and 95% CI. A two-tailed p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Clinical characteristics of ITP patients\u003c/h2\u003e \u003cp\u003eA total of 966 ITP patients were enrolled including 562 males (58.2%) and 404 females (41.8%). Age distribution: infancy (303, 31.4%), toddlerhood (230, 23.8%), preschool age (194, 20.1%), school age (202, 20.9%) and adolescence (37, 3.8%). 606 cases (62.7%) had a PLT counts\u0026thinsp;\u0026lt;\u0026thinsp;10 \u0026times;10⁹/L, 633 cases (65.5%) did not receive IVIG, 123 cases (12.7%) had GC tapered within one week, and 702 cases (72.7%) had no obvious triggering factors. Bleeding score distribution: 1 (384, 39.8%), 2 (466, 48.2%), 3(39, 4.0%), 5 (42, 4.3%) and 8 (35, 3.6%).\u003c/p\u003e \u003cp\u003eITP type: newly diagnosed ITP (849, 87.9%), persistent ITP (76,7.9%) and chronic ITP (41,4.2%). Treatment efficacy: achieved effective outcomes (854,88.4%) and ineffective (112, 11.6%), and relapse (61, 6.3%). Median follow-up duration was 110 days (IQR: 36\u0026ndash;680 days), shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Notably, significantly difference exists in trigger factors, bleeding scores, diagnostic type and therapeutic outcomes across various age stages, as shown in \u003cb\u003eTable \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and clinical characteristics of patients with ITP.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIneffective\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEffective\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e854 (88.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e562 (58.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e491 (87.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e404 (41.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e363 (89.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003einfancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e303(31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e288 (95.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etoddlerhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230(23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e204 (88.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epreschool age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194(20.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170 (87.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eschool age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202(20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159 (78.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadolescence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (89.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitial PLT counts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT counts\u0026thinsp;\u0026lt;\u0026thinsp;10 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e606(62.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e542 (89.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT counts\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e360 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e312 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIVIG status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno IVIG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e633(65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e565 (89.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVIG administrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e333(34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e289 (86.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGC taper time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123(12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (92.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e843(87.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e740 (87.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrigger factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno obvious factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e702 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e613 (87.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126 (92.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eviral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (91.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaccination\u0026thinsp;+\u0026thinsp;viral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (75.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBleeding score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e384(39.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e347(90.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e466 (48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e421 (90.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (17.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (82.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (69.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnostic type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enewly diagnosed ITP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e849 (87.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e801 (94.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epersistent ITP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echronic ITP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (68.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEfficacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimary failure\u003c/p\u003e \u003cp\u003e51 (5.3%)\u003c/p\u003e \u003cp\u003eRelapse after response\u003c/p\u003e \u003cp\u003e61 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003cp\u003e120 (12.4%)\u003c/p\u003e \u003cp\u003eCR\u003c/p\u003e \u003cp\u003e734 (76.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: Platelet:PLT, Intravenous immunoglobulin: IVIG, Glucocorticoid:GC, Complete response: CR, Partial response: (PR).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Cox analysis of efficacy.\u003c/h2\u003e \u003cp\u003eCox analysis was performed to identify factors influencing the treatment efficacy of pediatric ITP. Gender, initial PLT counts, and GC tapering time weren\u0026rsquo;t significantly associated with treatment efficacy. Age, Initial IVIG administration status, trigger factors, and bleeding scores were significantly associated with treatment efficacy. Further multivariate analysis results revealed that the risk of treatment ineffectiveness was increased in toddlerhood (HR\u0026thinsp;=\u0026thinsp;3.02, p\u0026thinsp;=\u0026thinsp;0.001, 95% CI: 1.56\u0026ndash;5.87), preschool age (HR\u0026thinsp;=\u0026thinsp;2.55,p\u0026thinsp;=\u0026thinsp;0.007, 95% CI: 1.29\u0026ndash;5.03), school age (HR\u0026thinsp;=\u0026thinsp;6.22, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI: 3.29\u0026ndash;11.76) and adolescence (HR\u0026thinsp;=\u0026thinsp;6.31,p\u0026thinsp;=\u0026thinsp;0.002, 95% CI: 1.99-20.00) compared with infancy, indicating that a significant decline in first-line treatment efficacy with increasing age. Compared with ITP patients without triggering factors, those with both vaccination and viral infection had a 3.89 times increased risk of treatment ineffectiveness (HR\u0026thinsp;=\u0026thinsp;3.89, p\u0026thinsp;=\u0026thinsp;0.028, 95% CI: 1.16\u0026ndash;13.02). Age and both vaccination history and viral infection as antecedent events of onset are independent risk factors for poor treatment efficacy in pediatric ITP, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. ROC curve analysis showed that AUC of age and triggering factors for predicting treatment efficacy in pediatric ITP was 0.642 and 0.535, respectively, as shown in \u003cb\u003eFig.\u0026nbsp;2\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox analysis results of efficacy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHazard ratio (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHazard ratio\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e562\u003c/p\u003e \u003cp\u003e(58.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e404\u003c/p\u003e \u003cp\u003e(41.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003cp\u003e(0.55,1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003einfancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003cp\u003e(31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etoddlerhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230\u003c/p\u003e \u003cp\u003e(23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.96\u003c/p\u003e \u003cp\u003e(1.56,5.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.02\u003c/p\u003e \u003cp\u003e(1.56,5.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epreschool age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003cp\u003e(20.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.65\u003c/p\u003e \u003cp\u003e(1.39,5.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003cp\u003e(1.29,5.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eschool age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202\u003c/p\u003e \u003cp\u003e(20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.69\u003c/p\u003e \u003cp\u003e(3.69, 12.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.22\u003c/p\u003e \u003cp\u003e(3.29,11.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadolescence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003cp\u003e(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.11\u003c/p\u003e \u003cp\u003e(1.99,18.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.31\u003c/p\u003e \u003cp\u003e(1.99, 20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitial PLT counts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT counts\u0026thinsp;\u0026lt;\u0026thinsp;10 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e606\u003c/p\u003e \u003cp\u003e(62.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ereference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT counts\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e360 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003cp\u003e(0.67,1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIVIG status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno IVIG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e633\u003c/p\u003e \u003cp\u003e(65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ereference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVIG administrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e333\u003c/p\u003e \u003cp\u003e(34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.51\u003c/p\u003e \u003cp\u003e(1.03,2.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003cp\u003e(0.900,2.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGC taper time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003cp\u003e(12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e843\u003c/p\u003e \u003cp\u003e(87.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003cp\u003e(0.77,3.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrigger factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno obvious cause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e702\u003c/p\u003e \u003cp\u003e(72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ereference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ereference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136\u003c/p\u003e \u003cp\u003e(14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003cp\u003e(0.26,0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003cp\u003e(0.48,1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eviral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003cp\u003e(12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003cp\u003e(0.26,0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003cp\u003e(0.32,1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaccination\u0026thinsp;+\u0026thinsp;viral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e(1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.10\u003c/p\u003e \u003cp\u003e(0.66,6.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.89\u003c/p\u003e \u003cp\u003e(1.16,13.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBleeding score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e384\u003c/p\u003e \u003cp\u003e(39.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ereference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ereference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e466\u003c/p\u003e \u003cp\u003e(48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003cp\u003e(0.52,1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003cp\u003e(0.54,1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003cp\u003e(4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003cp\u003e(0.75,3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003cp\u003e(0.48,2.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e(4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.11\u003c/p\u003e \u003cp\u003e(1.12,3.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003cp\u003e(0.67,2.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003cp\u003e(0.90,3.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003cp\u003e(0.60,2.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: Platelet:PLT, Intravenous immunoglobulin:IVIG, Glucocorticoid:GC.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Analysis of long-term prognosis diagnostic type.\u003c/h2\u003e \u003cp\u003eSubsequently, we evaluated the factors influencing diagnostic classification. Univariate analysis revealed that no significant associations between gender, initial PLT counts, initial IVIG administration status, GC tapering time and triggering factors and diagnostic classification of pediatric ITP. Age and bleeding score was significantly associated with ITP type. Further multivariate analysis results revealed that the risk of progression to persistent or chronic ITP in infancy and toddlerhood was 0.23 (p\u0026thinsp;=\u0026thinsp;0.001, 95% CI: 0.09\u0026ndash;0.55) and 0.38 (p\u0026thinsp;=\u0026thinsp;0.029, 95% CI: 0.16\u0026ndash;0.91) times that of adolescence, respectively. The risk of progressing to persistent of chronic ITP with bleeding score 1 or 2 was 0.33 (p\u0026thinsp;=\u0026thinsp;0.01, 95% CI: 0.14\u0026ndash;0.77) and 0.38 (p\u0026thinsp;=\u0026thinsp;0.024, 95% CI: 0.17\u0026ndash;0.88) times that of those with a bleeding score 8, respectively. Older age and higher bleeding score were independent risk factors for persistent and chronic ITP, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A significant difference in the distribution of diagnostic classification between patients who achieved a response within 28 days after treatment and those who achieved response after 28 days, as shown in \u003cb\u003eTable S2\u003c/b\u003e. Additionally, we explore the correlation between initial PLT counts and bleeding score. Spearman correlation analysis result showed that initial PLT counts has a negative correlation with bleeding score, but it was not statistically significant,as shown in \u003cb\u003eFigure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic analysis results of long-term prognosis Diagnostic subtype.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e562\u003c/p\u003e \u003cp\u003e(58.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003cp\u003e(0.63,1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.696\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e404\u003c/p\u003e \u003cp\u003e(41.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003einfancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003cp\u003e(31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003cp\u003e(0.09,0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003cp\u003e(0.09,0.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etoddlerhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230\u003c/p\u003e \u003cp\u003e(23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003cp\u003e(0.15,0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003cp\u003e(0.16,0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epreschool age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003cp\u003e(20.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003cp\u003e(0.23,1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003cp\u003e(0.22,1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eschool age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202\u003c/p\u003e \u003cp\u003e(20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003cp\u003e(0.28,1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003cp\u003e(0.26,1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadolescence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003cp\u003e(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitial PLT counts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT counts\u0026thinsp;\u0026lt;\u0026thinsp;10 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e606\u003c/p\u003e \u003cp\u003e(62.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003cp\u003e(0.61,1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT counts\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e360 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIVIG status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno IVIG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e633\u003c/p\u003e \u003cp\u003e(65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003cp\u003e(0.74,1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVIG administrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e333\u003c/p\u003e \u003cp\u003e(34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGC taper time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003cp\u003e(12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003cp\u003e(0.36,0.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e843\u003c/p\u003e \u003cp\u003e(87.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrigger factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno obvious cause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e702\u003c/p\u003e \u003cp\u003e(72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003cp\u003e(0.22,14.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136\u003c/p\u003e \u003cp\u003e(14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003cp\u003e(0.08,6.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eviral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003cp\u003e(12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003cp\u003e(0.15,11.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaccination\u0026thinsp;+\u0026thinsp;viral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e(1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBleeding score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e384\u003c/p\u003e \u003cp\u003e(39.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003cp\u003e(0.16,0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003cp\u003e(0.14,0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e466\u003c/p\u003e \u003cp\u003e(48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003cp\u003e(0.17,0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003cp\u003e(0.17,0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003cp\u003e(4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003cp\u003e(0.15,1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003cp\u003e(0.14,1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e(4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003cp\u003e(0.47,3.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003cp\u003e(0.32,2.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.837\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScore 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: Platelet:PLT, Intravenous immunoglobulin: IVIG, Glucocorticoid:GC.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Clinical characteristics and logistic analysis of relapse risk factors in ITP patients.\u003c/h2\u003e \u003cp\u003eAmong this cohort, 61 cases (57.4% male) relapsed after achieving treatment efficacy. Relapse mainly occurred post-infancy, with the highest prevalence in school age (36.1%) and was more frequent in patients who received IVIG therapy at initial diagnosis (67.2%) and those with chronic ITP (41%), as shown in \u003cb\u003eFigure S2\u003c/b\u003e. Subsequently, Univariate analysis results showed that gender, initial IVIG status, GC tapering time, and triggering factors were not significantly associated with relapse. While, age, initial PLT counts and bleeding score were significantly correlated with relapse. Further multivariate analysis results revealed that compared with infancy, the risk of relapse after response in toddlerhood, preschool age, and school age was increased by 3.31 (p\u0026thinsp;=\u0026thinsp;0.009, 95% CI: 1.49\u0026ndash;12.49), 4.78 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI: 2.04\u0026ndash;16.33) and 6.57 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI: 2.72\u0026ndash;21.03) times, respectively. Patients with an initial PLT counts\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026times;10⁹/L at diagnosis had a 1.94 time (p\u0026thinsp;=\u0026thinsp;0.017, 95% CI: 1.12\u0026ndash;3.35) increased risk of relapse compared with those with an initial PLT counts\u0026thinsp;\u0026lt;\u0026thinsp;10\u0026times;10⁹/L at diagnosis. Additionally, compared with a bleeding score 1, the relapse risk was increased by 3.33 (p\u0026thinsp;=\u0026thinsp;0.002, 95% CI:1.68\u0026ndash;11.14) and 7.41 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI: 3.09\u0026ndash;22.92) times in patients with bleeding score 5 and 8, respectively. These results indicated that older age, higher initial PLT counts and bleeding score were independent risk factors for relapse of pediatric ITP, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The ROC curve analysis showed that AUCs for predicting relapse were 0.663 (age), 0.571 (initial PLT counts) and 0.632 (bleeding score), as shown in \u003cb\u003eFig.\u0026nbsp;3\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic analysis results of relapse.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e526\u003c/p\u003e \u003cp\u003e(57.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e389\u003c/p\u003e \u003cp\u003e(42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.005\u003c/p\u003e \u003cp\u003e(0.59,1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003einfancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e293\u003c/p\u003e \u003cp\u003e(32.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etoddlerhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e218\u003c/p\u003e \u003cp\u003e(23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.96\u003c/p\u003e \u003cp\u003e(1.40, 11.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.31\u003c/p\u003e \u003cp\u003e(1.49,12.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epreschool age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188\u003c/p\u003e \u003cp\u003e(20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.10\u003c/p\u003e \u003cp\u003e(2.22,16.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.78 (2.04,16.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eschool age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e181\u003c/p\u003e \u003cp\u003e(19.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.97\u003c/p\u003e \u003cp\u003e(2.96,21.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.57\u003c/p\u003e \u003cp\u003e(2.72,21.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadolescence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.49\u003c/p\u003e \u003cp\u003e(0.65,18.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.73\u003c/p\u003e \u003cp\u003e(0.67,20.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitial PLT counts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT counts\u0026thinsp;\u0026lt;\u0026thinsp;10 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e572\u003c/p\u003e \u003cp\u003e(62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT counts\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e343\u003c/p\u003e \u003cp\u003e(37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.80\u003c/p\u003e \u003cp\u003e(1.07,3.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003cp\u003e(1.12,3.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitial IVIG administration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno IVIG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e606\u003c/p\u003e \u003cp\u003e(66.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVIG administrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e309\u003c/p\u003e \u003cp\u003e(33.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003cp\u003e(0.55,1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGC taper time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003cp\u003e(12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e797\u003c/p\u003e \u003cp\u003e(87.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.20\u003c/p\u003e \u003cp\u003e(0.78,6.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrigger factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno obvious cause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e661\u003c/p\u003e \u003cp\u003e(72.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003cp\u003e(14.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003cp\u003e(0.26,1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eviral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003cp\u003e(12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003cp\u003e(0.23,1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaccination\u0026thinsp;+\u0026thinsp;viral infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e(1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.84\u003c/p\u003e \u003cp\u003e(0.60,13.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBleeding score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e364\u003c/p\u003e \u003cp\u003e(39.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e444\u003c/p\u003e \u003cp\u003e(48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003cp\u003e(0.59,2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003cp\u003e(0.67,2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003cp\u003e(4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.19\u003c/p\u003e \u003cp\u003e(1.10,9.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.76\u003c/p\u003e \u003cp\u003e(0.93,8.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003cp\u003e(4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.63\u003c/p\u003e \u003cp\u003e(2.24,14.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.33\u003c/p\u003e \u003cp\u003e(1.68,11.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003escore 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003cp\u003e(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.53\u003c/p\u003e \u003cp\u003e(2.57,16.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.41\u003c/p\u003e \u003cp\u003e(3.09,22.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: Platelet:PLT, Intravenous immunoglobulin: IVIG, Glucocorticoid:GC.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study revealed that age is an independent risk factor for treatment efficacy, and age and bleeding score were independent risk factors for diagnostic ITP type. Additionally, age, bleeding score and initial PLT counts\u0026thinsp;\u0026ge;\u0026thinsp;10\u0026times;10⁹/L at diagnosis were independent factors for relapsed. Furthermore, we found that no significant associations between either GC tapering within 1 week or beyond 1 week, or IVIG administration status and treatment efficacy, diagnostic type or relapsed of pediatric ITP.\u003c/p\u003e \u003cp\u003eIn this study, we found pediatric ITP has a higher prevalence in infancy, with a male predominance, which is consistent with previous study[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Age presented as a consistent predictive factor for treatment efficacy, diagnosis type and relapse risk in pediatric ITP. Specifically, with increasing age, the risk of poor treatment efficacy, relapse and progression to chronic ITP was significantly elevated, which was similar to prior study[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The development of pediatric immunity system has an age distribution characteristic[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The immune system is immature in infancy, and immune tolerance possesses strong plasticity[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Consequently, infants with ITP are more likely to achieve treatment efficacy through spontaneous immune regulation, indicating favorable response to first-line therapy and a lower propensity to progress to persistent and chronic ITP.\u003c/p\u003e \u003cp\u003eIn this study, we identified that bleeding score is a common independent risk factor for both diagnosis type and the risk of relapse in pediatric ITP, indicating that the higher bleeding score was significantly associated with an increased risk of relapse and progression to persistent and chronic ITP. However, previous studies have reported no significant association between bleeding score and diagnosis type of pediatric ITP[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], which may be related with the sample size and the heterogeneity of the study population. A higher bleeding score essentially reflects a pathological state characterized by more severe vascular endothelial injury, abnormal platelet function or intense immune attack[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Persistent abnormal immune system is less likely to recover, thereby leading to the relapsed and chronic ITP[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Moreover, we found a negative correlation between initial PLT counts and bleeding score, but without statistical significance, consistent with previous report[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This further suggests that only PLT counts cannot fully explain the variations in bleeding scores.\u003c/p\u003e \u003cp\u003eIn this study, we found that initial PLT counts is also an independent risk to predict the relapse of children ITP. With increasing initial PLT counts, the risk of relapse of ITP is higher. A relatively higher PLT counts usually indicates a relatively mild degree of platelet destruction[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], while it doesn\u0026rsquo;t rule out the persistent abnormal activation of immune system, which may be a potentially crucial etiological factor for relapse of pediatric ITP. This finding suggests that a relatively higher initial PLT counts at diagnosis in pediatric ITP is not an indicator of favorable prognosis, but rather a potential signal of persistent immune activation and increased relapse risk in clinical practice.\u003c/p\u003e \u003cp\u003eAdditionally, we also found that individuals with both a vaccination and viral infection history had a significantly increased risk of treatment failure, compared with patients without identifiable triggers. Conversely, having only vaccination history or only viral infection did not affect the treatment efficacy in pediatric ITP, indicating that dual immune stimulation exacerbates immune mediated platelet destruction. Notably, we found that neither GC tapering within 1 week nor beyond 1 week, nor IVIG administration status, had a significant impact on treatment efficacy, diagnostic type and relapsed of pediatric ITP. These findings indicate that prolonging GC course or IVIG administrated fails to improve treatment efficacy or reduce the risk of relapse. Both GC and IVIG act by inhibiting immune activation-mediated platelet destruction to increase platelet counts in short term[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and extending the duration of GC use or adding IVIG doesn\u0026rsquo;t enhance treatment efficacy or long-term prognosis of pediatric ITP. Conversely, prolonged GC administration or additional IVIG use increases the risk of adverse effects and imposes a greater economic burden on patients\u0026rsquo; families[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, in the absence of severe bleeding or life-threatening conditions, observation alone or short time GC therapy is recommended as the first-line approach.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank the patients, their guardians and all investigators involved in this study. Additionally, the authors sincerely thank the Qiankun Yang’s guidance for this design and writing of manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding supported this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available on a reasonable request from the corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the legal guardians of each patients before collection and use of their clinical data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChiCTR2200055472.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by clinical Ethics Committee of the Children Affiliated hospital of Chongqing Medical University (Approval Number: 2021 Ethical Review (Research) No. 455)) and conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests disclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that no potential conflicts of interests existed in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJie Yu and Li Xiao\u003c/strong\u003e supervised the entire research process, from formulating the research design to performing data analysis and guiding the writing of the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLi Zhang\u003c/strong\u003e undertook the statistical analysis, interpretation of results, and wrote the initial manuscript, and completion of the revised manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJiebin Qin, Lan Huang, Xianhao Wen, Haiyan Liu, Yuxia Guo, Xingtian Xuan and Chunmei Xu\u003c/strong\u003e assisted in collecting data extraction, cleaning and analysis.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMarini I, Zlamal J, Faul C, Holzer U, Hammer S, Pelzl L, et al. Autoantibody-mediated desialylation impairs human thrombopoiesis and platelet lifespan. Haematologica. 2021;106:196\u0026ndash;207. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3324/haematol.2019.236117\u003c/span\u003e\u003cspan address=\"10.3324/haematol.2019.236117\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. 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Blood Rev. 2025;73:101300. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.blre.2025.101300\u003c/span\u003e\u003cspan address=\"10.1016/j.blre.2025.101300\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pediatric immune thrombocytopenia (ITP), age-specific clinical feature, prognosis risk factors, retrospective cohort study","lastPublishedDoi":"10.21203/rs.3.rs-8497619/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8497619/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo explore the clinical features, predictive factors for treatment efficacy, diagnostic type and relapse for pediatric immune thrombocytopenia (ITP).\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eRetrospective cohort study of 966 pediatric ITP individuals (2010\u0026ndash;2020, Children\u0026rsquo;s hospital of Chongqing medical university). Demographic data, platelet counts, triggers, treatments, bleeding scores, and outcomes were collected. Analysis included Chi-square test, Cox regression (efficacy), Logistic regression (diagnostic type and relapse ) and ROC curves.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere are significant differences in the trigger factors(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), bleeding score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), diagnostic type(p\u0026thinsp;=\u0026thinsp;0.003), and treatment efficacy(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) of pediatric ITP among various stages of childhood. Risk factors for poor efficacy: older age (toddlerhood to adolescence: HR\u0026thinsp;=\u0026thinsp;3.02\u0026ndash;6.31, p\u0026thinsp;\u0026lt;\u0026thinsp;0.007) and viral infection with vaccination triggers (HR\u0026thinsp;=\u0026thinsp;3.89, P\u0026thinsp;=\u0026thinsp;0.028). Protective factors for favorable diagnostic type: infancy/toddlerhood (OR\u0026thinsp;=\u0026thinsp;0.23\u0026ndash;0.38,p\u0026thinsp;\u0026le;\u0026thinsp;0.029) and lower bleeding scores (OR\u0026thinsp;=\u0026thinsp;0.33\u0026ndash;0.38,p\u0026thinsp;\u0026le;\u0026thinsp;0.024). Relapse risks: older age (OR\u0026thinsp;=\u0026thinsp;4.31\u0026ndash;7.57,p\u0026thinsp;\u0026le;\u0026thinsp;0.007),platelet counts\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026times;10⁹/L(OR\u0026thinsp;=\u0026thinsp;1.94, p\u0026thinsp;=\u0026thinsp;0.017) and high bleeding scores (OR\u0026thinsp;=\u0026thinsp;4.33\u0026ndash;8.41, p\u0026thinsp;\u0026le;\u0026thinsp;0.002). Glucocorticoid (GC) tapering time and IVIG status had no impact (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePediatric ITP exhibits age-specific clinical/prognostic patterns. Age,bleeding score, platelet counts and dual triggers are independent prognostic factors. Short-course GC therapy is recommended.\u003c/p\u003e","manuscriptTitle":"Age-specific clinical features and prognostic risk factors in pediatric ITP: A single-center retrospective cohort study of 966 cases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 08:49:26","doi":"10.21203/rs.3.rs-8497619/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fc36afb1-79eb-4cb2-9347-ddb2f2c6b31a","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-18T06:56:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 08:49:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8497619","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8497619","identity":"rs-8497619","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}