[Prognostic Factors in Children with Hemophagocytic Lymphohistiocytosis: A Retrospective Cohort Study]
1Department of Laboratory Medicine, Women and Children's Hospital, Southern University of Science and Technology, Guangzhou 511400, Guangdong Province, China.
Objective:
To investigate the factors associated with prognosis in children diagnosed with hemophagocytic lymphohistiocytosis (HLH).
Methods:
A retrospective analysis was conducted on clinical data from 75 pediatric patients diagnosed with HLH at Guangdong Women and Children Hospital between January 2018 and December 2022. Patients were categorized into survival and death groups according to clinical outcomes. Demographic characteristics, clinical manifestations, and laboratory findings were compared between the two groups. Univariate and multivariate logistic regression analysis were performed to identify independent prognostic factors, while receiver operating characteristic (ROC) curve analysis was employed to assess the discriminative performance of individual markers and a combined predictive model.
Results:
A total of 75 HLH cases were included, with an overall mortality rate of 32% (24/75). Compared to the survival group, children in the death group were younger, with significantly elevated levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), activated partial thromboplastin time(APTT), prothrombin time (PT), and thrombin time (TT), while total protein (TP), albumin (ALB), triglycerides (TG), and fibrinogen (FBG) were significantly reduced (P<0.05). Multivariate logistic regression revealed that age (OR=0.661, 95%CI: 0.460-0.949, P=0.025), APTT(OR=1.082, 95%CI: 1.032-1.136, P=0.001), and FBG levels (OR=0.376, 95%CI: 0.148-0.959, P=0.041) were independent prognostic factors for children with HLH. ROC curve analysis demonstrated that the combination of age, APTT, and FBG exhibited superior predictive accuracy for adverse outcomes compared to any single marker, yielding an area under the curve (AUC) of 0.880 (95%CI: 0.789-0.971), with a sensitivity of 91.67% and specificity of 78.43%.
Conclusion:
Younger age, prolonged APTT, and decreased FBG level are significant predictors of poor prognosis in pediatric HLH patients, and their integration into a combined model can improve prediction performance.