Transfusion Requirements and 30-Day Mortality Predictors for Adult Hemophagocytic Lymphohistiocytosis
Otrock ZK, Grossman BJ, and Eby CS. Transfusion requirements and 30-day mortality predictors for adult hemophagocytic lymphohistiocytosis. Int J Hematol 2018.
Int J Hematol
Hemophagocytic lymphohistiocytosis (HLH) is a rare clinical syndrome characterized by an uncontrolled hyper-inflammatory response. We assessed the transfusion requirements and predictors of 30-day mortality for adult HLH patients. We identified all adult patients with a diagnosis of HLH at a large academic hospital from October 2003 through February 2017. We extracted patients' clinical and laboratory data, including transfusion requirements, from their medical records. One-hundred sixteen patients were identified. Their median age was 48 years (range 18-82); 72(62%) were male. Median duration of hospital stay was 19 days (range 1-89 days). At 30 days from admission, 81(70%) patients were alive. Death was attributed to sepsis in 21 patients, lymphoma in six, bleeding in four, GVHD in one, liver failure in one, metastatic solid tumor in one, and unknown in one. Transfusion requirements at 30 days from admission were as follows: RBC, 86% of patients, median 6 units (range 1-58); platelets, 74% of patients, median 6 units (1-67); plasma, 40% of patients, median 4 units (1-56). Renal failure (OR = 4.39; P = 0.008) and hypofibrinogenemia (OR = 4.07; P = 0.009) correlated with 30-day mortality. The transfusion requirements for adult HLH patients were high. Our study indicated that renal insufficiency and hypofibrinogenemia are predictors of early death in adult HLH.
Medical Subject Headings
Adolescent; Adult; Aged; Aged, 80 and over; Blood Transfusion; Disease-Free Survival; Female; Humans; Length of Stay; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Survival Rate; Time Factors
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