Clinical characteristics and survival analysis of aplastic anaemia patients at the University Teaching Hospitals, Lusaka

Abstract

The current study aimed at assessing the characteristics of patients with aplastic anaemia and determining survival rates and predictors of survival for patients diagnosed with aplastic anaemia at the University Teaching Hospitals (UTH), Lusaka, Zambia. A retrospective cohort study was conducted at UTH, Lusaka, Zambia. The included cases were patients diagnosed with aplastic anaemia from 2014 to 2023. Data was collected through review of patients’ medical records. Kaplan-Meier plots were used in the analysis of time-to-event data for estimation of survival probabilities. The log-rank test was utilized to make comparisons between survival curves. Cox proportional hazards regression was used to analyze risk factors for survival. Data analysis was done using R version 4.3.2. A total of 126 cases were included, 96 paediatric cases and 30 adult cases, from 2014 to 2023. For paediatric patients, 52.08%(n=50) were females while for adult patients, 73.33% (n =22) were male. The median age at diagnosis was 11 years (IQR =12) and 22.5 years (IQR = 36) in paediatrics and adults, respectively. The most common cause of aplastic anaemia was unknown in both paediatrics and adults. Most of the participants had NSAA followed by SAA and VSAA in both groups. The mortality rate was 21.88% and 46.67% in paediatrics and adults, respectively. The median survival time from diagnosis was found to be 65 months in the paediatric cases. The 1-year survival rate was found to be at 43% and 53% in paediatrics and adults, respectively. The study did not find any factors to be independent predictors of survival among paediatrics patients with aplastic anaemia in both groups. Analysis of all the patients revealed a slight male predominance, a median age of 12 years and a median survival time of 65 months. The study reports a mortality rate and a 1-year survival rate of 27.78% and 42%, respectively. The study found that being a paediatric conferred superior survival while (HR = 0.33, 95%CI 0.17 – 0.66, p =0.002) and presenting with bleeding was an independent predictor of inferior survival (HR = 2.90, 95% CI 1.25 – 6.71, p = 0.013). Paediatric aplastic anaemia patients have better survival and haemorrhage remains a major predictor for mortality. An improvement in the management of adult aplastic anaemia patients in needed. Prevention, early identification and treatment of bleeding is needed. Availability, accessibility and affordability of treatment are recommended. Key words: Aplastic anaemia, Survival analysis, Immunosuppressive therapy, pancytopaenia, Zambia