In total, an estimated 2110 COVID-19-positive adult patients reported an event of ITP among 1273470 adult COVID-19 admissions between April 1st, 2020, and November 30th, 2020(167 cases per 100,000 COVID-19 admissions). The ITP patients were older, with a mean age of 64.15 years (vs. 62.80, p < 0.01). Moreover, they were more likely to be Female (aOR 1.17, 95% CI 1.067–1.283, p < 0.01), patients with co-existing chronic kidney disease (CKD)(aOR 1.277, 95% CI 1.134–1.439, p < 0.01), past history of stroke (aOR 1.235, 95% CI 1.044–1.460, p < 0.01), cirrhosis (aOR 2.726, 95% CI 2.315–3.209, p < 0.01 ), obesity (aOR 1.208, 95% CI 1.091–1.338, p < 0.01 ), HIV status (aOR 1.957, 95% CI 1.252–3.058, p < 0.01 ), or cachexia (aOR 1.425, 95% CI 1.013–2.003, p = 0.042 ). In addition, a higher prevalence of multiple autoimmune conditions such as systemic lupus erythematosus (SLE) (aOR 5.195, 95% CI 4.019–6.714, p < 0.01), Sjogren disease (aOR 1.865, 95% CI 1.091–3.189, p = 0.023), rheumatoid arthritis (RA) (aOR 1.918, 95% CI 1.545–2.381, p < 0.01), and hypothyroidism (aOR 1.321, 95% CI 1.174–1.486, p < 0.01 ) were seen among COVID-19 patients that reported ITP. ITP patients were more likely to involve those with a history of neoplasm (malignant or benign) (aOR 1.841, 95% CI 1.598–2.121, p < 0.01 ) and overall had a higher mean CCI score (mean score of 3.72 vs. 2.75, p < 0.01, with a higher prevalence of patients with CCI ≥ 3, aOR 1.22, 95% CI 1.085–1.372, p < 0.01).
On the other hand, we also noted racial disparities as compared to Whites with COVID-19, Blacks (aOR 0.504, 95% CI 0.439–0.579, p < 0.01), Hispanics (aOR 0.726, 95% CI 0.642–0.820, p < 0.01), and Asian/Pacific Islanders (aOR 0.54, 95% CI 0.404–0.761, p < 0.01) with COVID-19 were linked with lower incidence of ITP. COVID-19 patients covered under private forms of payment also reported fewer ITP events (aOR 0.823, 95% CI 0.722–0.939, p < 0.01 ) as compared to Medicare users. Those with diabetes (aOR 0.876, 95% CI 0.791–0.969, p < 0.01), hypertension (aOR 0.799, 95% CI 0.717–0.890, p < 0.01), and peripheral vascular disease had lower odds of ITP.
Finally, we also observed poorer prognosis in COVID-19 cases with ITP as 19.2% of ITP cases did not survive (vs. 13.4% of non-ITP COVID-19 positive patients, aOR 1.235, 95% CI 1.095–1.392, p < 0.01) (Table 1)
Table 1
Adjusted Odds Ratio of events of ITP among COVID-19-positive adults between April and November 2020
Variable | p-value | aOR | Lower 95% CI | Upper 95% CI |
Female | < .001 | 1.17 | 1.067 | 1.283 |
Primary payer (Medicare as reference) |
Medicaid | 0.849 | 1.015 | 0.868 | 1.187 |
Private | 0.004 | 0.823 | 0.722 | 0.939 |
White as reference |
Black | < .001 | 0.504 | 0.439 | 0.579 |
Hispanic | < .001 | 0.726 | 0.642 | 0.82 |
Asian/Pacific Islanders | < .001 | 0.554 | 0.404 | 0.761 |
Hypertension | < .001 | 0.799 | 0.717 | 0.89 |
Dyslipidemia | 0.349 | 0.954 | 0.864 | 1.053 |
Smoking | 0.345 | 0.95 | 0.855 | 1.056 |
Diabetes | 0.01 | 0.876 | 0.791 | 0.969 |
CKD | < .001 | 1.277 | 1.134 | 1.439 |
PVD | 0.037 | 0.727 | 0.539 | 0.981 |
Previous Stroke | 0.014 | 1.235 | 1.044 | 1.46 |
Cirrhosis | < .001 | 2.726 | 2.315 | 3.209 |
Alcohol Abuse | 0.446 | 0.902 | 0.692 | 1.175 |
Old MI | 0.103 | 1.179 | 0.967 | 1.437 |
Obesity | < .001 | 1.208 | 1.091 | 1.338 |
HIV | 0.003 | 1.957 | 1.252 | 3.058 |
Cachexia | 0.042 | 1.425 | 1.013 | 2.003 |
Drug Abuse | 0.874 | 1.023 | 0.776 | 1.347 |
COPD | 0.212 | 0.922 | 0.812 | 1.048 |
Systemic lupus erythematosus (SLE) | < .001 | 5.195 | 4.019 | 6.714 |
Sjogren | 0.023 | 1.865 | 1.091 | 3.189 |
Rheumatoid arthritis (RA) | < .001 | 1.918 | 1.545 | 2.381 |
Hypothyroidism | < .001 | 1.321 | 1.174 | 1.486 |
Neoplasm | < .001 | 1.841 | 1.598 | 2.121 |
Age ≥ 60 years | 0.199 | 0.922 | 0.815 | 1.044 |
CCI Score ≥ 3 | < .001 | 1.22 | 1.085 | 1.372 |