Risk factors of early death in adult patients with secondary hemophagocytic lymphohistiocytosis: a single-institution study of 171 Chinese patients

Zhao, Yuechao; Lu, Debin; Ma, Shanshan; Li, Li; Zhu, Jingjing; Zhou, De; Zheng, Yunquan; Yang, Xiudi; Zhu, Lixia; Zhu, Mingyu; Xie, Mixue; Sun, Jianai; Ye, Xiujin; Xie, Wanzhuo

doi:10.1080/16078454.2019.1660458

Cited by 38 publications

(45 citation statements)

References 41 publications

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“…In our study, no statistically significant differences were observed between the different subgroups (24). This may be due to the fact that the AI subgroup presented lower mortality and a greater liver alteration.…”

Section: Discussioncontrasting

confidence: 74%

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Secondary Hemophagocytic Syndrome: Differences between the etiologies autoimmunes and hematological malignancies subgroup

Dubuc¹,

Calvo‐Alén²,

Mir³

et al. 2020

Preprint

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Background: Hemophagocytic Syndrome (HPS) is an uncommon disorder with high mortality. HPS is reported to be usually related to some underlying conditions; autoimmune (AI) and hematological malignancies (HM) are two main underlying conditions. Here, we attempted to determine the clinical characteristics/differences of HPS according to underlying conditions; AI vs. HM, based on our experience. Methods: We studied all adult patients with HPS diagnosed at our institution from 2005 to 2019. Demographic, clinical characteristics, laboratory findings, underlying disorders, hospital stay and prognosis variables were examined and related to the underlying conditions. Results: 30 patients (median age of 55 years and male/female of 14/16) met the inclusion criteria which we analyzed: HM: 12 (40%), AI: 10 (33%), and others: 8 (27%). HM group, compared with AI group, showed a significantly longer length hospital stay (HM vs AI: 61.5 vs 30.5 (median)), more severe thrombocytopenia, leukocytopenias, and neutropenia, and importantly, higher mortality (with overall mortality and HM-related HPS-mortality being 43.3 and 66.7%, respectively). Contrarily, HM group, compared with AI group, showed less severe liver abnormalities (AST; 106 vs 457 (median): ALT; 109 vs 457 (median)). Conclusions : The HM subgroup presented a greater mortality and a higher number and severe cytopenias but lower elevation of transaminases.

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Section: Discussioncontrasting

confidence: 74%

“…In general, the malignant neoplasms underlying HPS, especially lymphoma, are considered an adverse prognostic factor. (10,11,24,27).…”

Section: Discussionmentioning

confidence: 99%

Secondary Hemophagocytic Syndrome: Differences between the etiologies autoimmunes and hematological malignancies subgroup

Dubuc¹,

Calvo‐Alén²,

Mir³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In summary, thrombocytopenia results in an increased risk of bleeding, impaired immune response, and bone marrow failure, suggesting a worse prognosis. were no differences between the etiological subgroups or by survival group, unlike other studies, where hypertriglyceridemia proved to be a predictor of adverse outcome [14]. This may be because most of our patients in the survival group were patients with AI disease, who had lower mortality and greater liver alteration.…”

Section: Discussioncontrasting

confidence: 62%

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2020

Int J Rare Dis Disord

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Background: The mortality rate of Hemophagocytic Syndrome (HPS) is 26.5%-74.8%. Malignant neoplasms, hyperferritinemia, thrombocytopenia, older age, hypertriglyceridemia, and prolonged prothrombin are considered to be adverse prognostic factors. This study describes the underlying features of patient's survivors and non-survivors with HPS from one hospital between 2005-2019. Methodology: This is a retrospective study. We included patient with HPS diagnosis based on the HLH-2004 criteria, or who presented hemophagocytic cells in the bone marrow biopsy, or who had HPS diagnosis in the hospital discharge report. Demographic, clinical characteristics, underlying disorders and prognosis factors variables were collected. Kruskal Wallis, Fisher test and Mann-Whitney U test were used for the bivariate analysis. Kaplan-Meier method was utilized to calculate their survival rates. Results: Thirty patients were included. The median age was 55 years (± 18.3); 16 (53.3%) were female. The Hematological Malignancies (HM) subgroup had more and severe cytopenias [hemoglobin 6.5 (5.9-7.3; p 0.120), platelets 4500 (650-15,750; p 0.009), leukocytes 2050 (20-728; p 0.0001) and neutrophils 0 (0-280; p 0.002)]. The non-survivor group had a longer time of prolongation of the lNR [2.1 (1.2-3.7) versus 1.5 (1.1-1.6); p 0.028] and an older age at diagnosis of HPS [68 years (58.2-74.5) versus 40 years (34-57); p 0.043] versus the survivor group. The overall intrahospital mortality was 43.3%, being greater in HM subgroup [8 patients (66.7%); p 0.029]. Conclusions: The HM subgroup had a higher mortality, and a greater number and severe cytopenias. The non-survivor group had a longer time of INR and a higher age at the moment of diagnosis of HPS.

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“…LDH was often regarded as an indicator of organ injury and tumor burden. 18 Previous studies found that high level LDH were common in severe cases and correlated with severe acute lung injury. 12,16 The present study revealed that high level LDH was associated with prolongation of viral shedding time, which may be due to the severe lung injury.…”

Section: Discussionmentioning

confidence: 99%

Systemic Inflammatory Cytokines Associate With SARS-COV-2 Viral Shedding Time in Covid-19 Inpatients

Shi¹,

Cheng²,

Yu³

et al. 2020

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Background: Since December 2019, coronavirus disease 2019 (COVID-19), as an infectious disease with cytokine storm, has become an emerging global challenge. To assess the duration of SARS-COV-2 viral shedding and associated risk factors in COVID-19 patients.Methods: COVID-19 patients with interleukin (IL)-1b, soluble interleukin-2 receptor (sIL-2R), IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α cytokines data consecutively admitted to Tongji Hospital from January 27, 2020 through February 5, 2020 were enrolled and been followed up until March 24, 2020. We utilized Kaplan-Meier method and Cox proportional hazards regression analysis to assess the duration of viral shedding and risk factors affecting virus clearance.Results: 246 inpatients with laboratory confirmed COVID-19 were enrolled. The median duration of viral shedding was 24 days, ranging from 6 to 63 days. Age, severity of COVID-19, albumin, lactate dehydrogenase (LDH), D-dimer, ferritin and sIL-2R were associated with duration of viral shedding. Administration of lopinavir-ritonavir, arbidol, oseltamivir and intravenous immunoglobulin did not shorten viral shedding time. Multivariate cox regression analysis revealed that sIL-2R, LDH and severity of COVID-19 were independent factors associated with duration of viral shedding. At stratified analysis, the viral shedding time was positively correlated with age, sIL-2R and LDH in non-corticosteroid subgroup, while negatively correlated with lymphocyte count in corticosteroid group. Conclusions: The present study demonstrated that elevated sIL-2R, increased LDH and severe status were related to prolongation of viral shedding in COVID-19 inpatients. Further research is urgent to investigate the mechanism of immune reaction involved in the virus clearance process and aim to the optimal antiviral therapy.

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Risk factors of early death in adult patients with secondary hemophagocytic lymphohistiocytosis: a single-institution study of 171 Chinese patients

Cited by 38 publications

References 41 publications

Secondary Hemophagocytic Syndrome: Differences between the etiologies autoimmunes and hematological malignancies subgroup

Secondary Hemophagocytic Syndrome: Differences between the etiologies autoimmunes and hematological malignancies subgroup

Untitled

Systemic Inflammatory Cytokines Associate With SARS-COV-2 Viral Shedding Time in Covid-19 Inpatients

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