Characteristics of Corticosteroid-Resistant Secondary Immune Thrombocytopenia Associated With Connective Tissue Diseases in China: A Retrospective Comparative Study

Abstract

Objective

Corticosteroid-resistant secondary immune thrombocytopenia (ITP) is a challenging condition in clinical practice. This study aimed to explore the clinical and immunological characteristics of corticosteroid-resistant secondary ITP associated with connective tissue diseases (CTD-ITP).

Methods

We conducted a retrospective analysis of 201 CTD-ITP hospitalized patients between 2014 and 2022. Patients were categorized as corticosteroid-resistant or corticosteroid-sensitive, and their demographic, clinical, and immunological data were compared. Logistic regression analysis was employed to identify independent predictors of corticosteroid resistance.

Results

Corticosteroid resistance was observed in 27.4% of patients. Compared with the corticosteroid-sensitive group, the corticosteroid-resistant group exhibited a higher percentage of CD3⁺ T cell (71.38% vs. 64.70%, p = 0.004) and CD3⁺CD8⁺ T cell (38.55% vs. 28.95%, p = 0.003), but a lower percentage of CD19⁺ B cell (13.70% vs. 22.45%, p = 0.001) in peripheral blood. No significant differences were found in other demographics, clinical features, or autoantibody profiles. The multivariable logistic regression analysis showed that higher percentage of CD3⁺CD8⁺ T cells (OR = 1.170, 95% CI: 1.014–1.350, p = 0.031) was an independent risk factor for corticosteroid resistance in CTD-ITP patients.

Conclusion

This study revealed the potential role of higher CD3⁺CD8⁺ T cells in corticosteroid resistance among CTD-ITP patients, and provided the potential biomarker for predicting corticosteroid therapy response.