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

Hematology ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 606-612 ◽  
Author(s):  
Yanchun Zhao ◽  
Danlei Lu ◽  
Shanshan Ma ◽  
Li Li ◽  
Jingjing Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Early Death ◽  
Adult Patients ◽  
Chinese Patients ◽  
Single Institution ◽  
Secondary Hemophagocytic Lymphohistiocytosis

scholarly journals Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mei Meng ◽  
Limin Chen ◽  
Sheng Zhang ◽  
Xuan Dong ◽  
Wenzhe Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Organ Failure ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Viral Infections ◽  
Adult Patients ◽  
Reactive Protein ◽  
Failure Assessment ◽  
Life Threatening ◽  
Independent Risk Factors ◽  
Secondary Hemophagocytic Lymphohistiocytosis

Abstract Background Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event and a fatal complication of viral infections. Whether sHLH may also be observed in patients with a cytokine storm induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still uncertain. We aimed to determine the incidence of sHLH in severe COVID-19 patients and evaluate the underlying risk factors. Method Four hundred fifteen severe COVID-19 adult patients were retrospectively assessed for hemophagocytosis score (HScore). A subset of 7 patients were unable to be conclusively scored due to insufficient patient data. Results In 408 patients, 41 (10.04%) had an HScore ≥169 and were characterized as “suspected sHLH positive”. Compared with patients below a HScore threshold of 98, the suspected sHLH positive group had higher D-dimer, total bilirubin, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, serum creatinine, triglycerides, ferritin, interleukin-6, C-reactive protein, procalcitonin, lactate dehydrogenase, creatine kinase isoenzyme, troponin, Sequential Organ Failure Assessment (SOFA) score, while leukocyte, hemoglobin, platelets, lymphocyte, fibrinogen, pre-albumin, albumin levels were significantly lower (all P < 0.05). Multivariable logistic regression revealed that high ferritin (>1922.58 ng/mL), low platelets (<101 × 109/L) and high triglycerides (>2.28 mmol/L) were independent risk factors for suspected sHLH in COVID-19 patients. Importantly, COVID-19 patients that were suspected sHLH positive had significantly more multi-organ failure. Additionally, a high HScore (>98) was an independent predictor for mortality in COVID-19. Conclusions HScore should be measured as a prognostic biomarker in COVID-19 patients. In particular, it is important that HScore is assessed in patients with high ferritin, triglycerides and low platelets to improve the detection of suspected sHLH.

Risk Factors for Early Fatal Outcomes Among Children with Hemophagocytic Lymphohistiocytosis (HLH): A Single-Institution Case-Series in Vietnam

2013 ◽  
Vol 31 (3) ◽  
pp. 271-281 ◽  
Author(s):  
An T. T. Dao ◽  
Van T. Luong ◽  
Tinh T. Nguyen ◽  
Quynh T. V. Huynh ◽  
Trang T. T. Phan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Case Series ◽  
Single Institution

scholarly journals Partial Upper Sternotomy for Extensive arch Repair in Older Acute type A Aortic Dissection Patients

2021 ◽  
Author(s):  
Zhihuang Qiu ◽  
Jun Xiao ◽  
Qingsong Wu ◽  
Tianci Chai ◽  
Li Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Aortic Dissection ◽  
Older Adult ◽  
Early Death ◽  
Type A ◽  
Adult Patients ◽  
Long Term Results ◽  
Acute Type ◽  
Type A Aortic Dissection

Abstract Objectives: The partial upper sternotomy (PUS) approach is acceptable for aortic valve replacement, and even aortic root operation. However, the efficiency of PUS for extensive arch repair of acute type A aortic dissection (AAAD) in older adult patients has not been well investigated.Methods: Between January 2012 and December 2019, 222 older adult patients (≥65 years) diagnosed with AAAD went through extensive arch repair, among which 127 received PUS, and 95 underwent full sternotomy (FS). Logistic regression analysis was used to identify risk factors for early death, and negative binomial regression analysis was applied to explore risk factors related to post-operative ventilator-supporting time and intensive care unit stay time. Results: Total early mortality was 8.1% (18/222 patients). The PUS group had shorter Cardiopulmonary bypass time (133.0 vs.155.0 minutes, P<0.001), cross-clamp time (44.0 vs. 61.0 minutes, P<0.001) and shorter selective cerebral perfusion time (11.0 vs. 21.0 minutes, P<0.001) than the FS group. Left ventricle ejection fraction (LVEF)<50% (odds ratio [OR], 17.05; 95% confidence interval [CI] 1.87-155.63; P=0.012) and malperfusion syndromes (OR, 65.83; 95% CI 11.53-375.86; P<0.001) were related to early death. In the multivariate model, the PUS approach contributed to shorter ventilator-supporting time (incidence rate ratio [IRR], 0.76; 95% CI 0.64-0.91; P=0.003) , when compared with the FS group. Conclusions: The early results of emergency extensive arch repair of AAAD via PUS in older adult patients were satisfactory. However, the long-term results remain to be investigated.

scholarly journals Development and Initial Validation of a Novel Prognostic Model in Adult Secondary Hemophagocytic Lymphohistiocytosis Patients: Experience From a Single-center Retrospective Study

2021 ◽  
Author(s):  
Dongguang Wang ◽  
Xiang Tong ◽  
Lian Wang ◽  
Wentao Zhang ◽  
Shijie Zhang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Predictive Model ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Poor Prognosis ◽  
Prognostic Model ◽  
Validation Cohort ◽  
Adult Patients ◽  
Logistic Regression Models ◽  
Patients With Poor Prognosis ◽  
Secondary Hemophagocytic Lymphohistiocytosis

Abstract Objectives: To describe the prognostic factors of adult patients diagnosed with secondary hemophagocytic lymphohistiocytosis (HLH), a rare disease caused by excessive immune activation and uncontrolled cytokine storm, and to establish and initially validate the predictive value of a prognostic model.Methods: We conducted a retrospective cohort study of 204 adult secondary HLH patients from January 2010 to December 2018 (the development cohort, n=161) and January 2019 to December 2020 (the validation cohort, n=43). All patients met ≥5 HLH-2004 criteria. Prognostic variables to death within three months at diagnosis were selected by logistic regression models, and performance of the predictive model was assessed in development and validation cohort, respectively.Results: Of all patients, malignancies were the most common trigger, accounting for 61.3%. Patients with poor prognosis showed lower hemoglobin (P<0.001), platelets (P<0.001), albumin (P=0.007) and fibrinogen (P=0.002), and higher levels of total bilirubin (P=0.007), LDH (P=0.033), BUN (P=0.006), and TG (P=0.015). Furthermore, patients with poor prognosis had a higher ISTH score (P<0.001). In the development cohort, a predictive model was established based on four variables (splenomegaly, hemoglobin, LDH and ISTH score) recognized by the multivariate logistic regression, with the cut-off value of 0.277 reaching a sensitivity of 87.7%, specificity of 49.0% and AUC of 0.731 (95%CI 0.651-0.810, P<0.001). Besides, the model could perform well in the validation cohort, with a sensitivity of 53.8%, specificity of 40.0% and accuracy of 44.2%.Conclusions: Our predictive model provides a possibility of forecasting the prognosis of adult patients within three months at diagnosis of secondary HLH, while more large sample, multicenter, randomized controlled clinical research are needed to confirm it.

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