Revisiting Pediatric ITP Prognosis: A Systematic Review and Meta-analysis of Simple Clinical and Laboratory Predictors of Chronic Disease

Background: Pediatric immune thrombocytopenia (ITP) usually has a favorable prognosis, although some children progress to chronic disease (>12 mo). A 2014 meta-analysis by Heitink-Pollé and colleagues identified important prognostic markers that informed tools such as the Nordic prediction score. Given advances in diagnosis over the past decade, updated evidence focusing on simple bedside predictors is needed. Objective: To evaluate post-2014 evidence on baseline clinical and laboratory predictors of chronic pediatric ITP. Methods: Following PRISMA 2020 guidelines, PubMed and Embase were searched for observational studies. Of 876 identified records, 26 studies were included in the systematic review and 24 in the meta-analysis (N>4000). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Results: Older age at diagnosis (OR 2.25) and insidious onset (OR 6.20) remained the strongest predictors of chronicity. Absence of preceding infection (OR 2.66) and female sex (OR 1.43) were also associated with chronic disease. Higher baseline platelet count (OR 2.14) demonstrated a similar trend, though this finding is limited by extreme heterogeneity ( I 2 =78%) across studies. In a single study, mild bleeding predicted chronicity compared with moderate/severe bleeding (OR 2.86). Conclusion: These findings validate the Nordic Score framework and support risk stratification using simple, reproducible clinical parameters.