Int J Clin Pract. 2020 Sep 15:e13704. doi: 10.1111/ijcp.13704. Online ahead of print.
AIMS: The relationship between ferritin levels and survival in adult hemophagocytic lymphohistiocytosis (HLH) has been evaluated in previous studies. However, Admission-to-discharge percentage ferritin reduction (named as ferritin index) level in adult patients with HLH has never been evaluated to predict 6-month survival.
METHODS: The demographic, laboratory and clinical information of 102 newly diagnosed adult HLH patients was collected. Regression analysis, receiver operating curve and Kaplan-Meier curves were analyzed to explore the performance of ferritin levels.
RESULTS: Ferritin index and discharge ferritin level were significantly different between survivor and non-survivor group (all p <0.001). Ferritin index had the highest area under the curve (AUC) for predicting the survival (AUC = 0.802, p < 0.001) followed by discharge ferritin (AUC = 0.746, p < 0.001). Kaplan-Meier analysis showed a significant difference in survival according to optimum cutoff values of ferritin index ≥10.19% (p < 0.001) or discharge ferritin ≤1056.1 μg/L (P < 0.001). Multivariate analysis confirmed that ferritin index and discharge ferritin are independent predictors of 6-month survival (ferritin index: odds ratio (HR) 6.237, 95% confidence interval (CI) 2.075-18.774, p = 0.001; discharge ferritin: HR 6.024, 95% CI 1.894-19.231, p= 0.002). In addition, the combination of a ferritin index ≥10.19% and discharge ferritin ≤1056.1 μg/L had a significantly higher 6-month survival (P < 0.001).
CONCLUSION: Ferritin index is a better predictor of 6-month survival than admission and discharge ferritin levels in adult patients with HLH.