Автор:
Titov A., Potapenko V., Pervakova M., Lapin S., Klimovich A., Pavluchenko E., Karev V., Potikhonova N., Medvedeva N.
Год:
2019
Файл:
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Публикация: Clinical Lymphoma, Myeloma and Leukemia 19:S351. September 2019
Ключевые слова: HLH, hemophagocytic lymphohisteocytosis, sepsis, ferritin, MPN, myeloproliferative neoplasms
Аннотация
Context: Sepsis and secondary hemophagocytic lymphohisteocytosis (sHLH) have common clinical and laboratory landscapes although they should be managed differently. Several attempts for development of tools useful in distinguishing these conditions were made (such as glycosylated ferritin measurement or Hscore) but their clinical availability is low.
Objective: To evaluate the usefulness of ferritin/S-reactive protein ratio in distinguishing sepsis and sHLH.
Design: The data from 118 patients (prospectively in 52 patients) were analyzed: 54 pts with sHLH (median age 57.5, range 2-81 years) and 65 with sepsis (median age 64, range 5-89 years). The sHLH diagnosis was based on HLH-2004 criteria. The disease manifested predominantly with unexplained fever and cytopenia and the underlining cause for sHLH in most cases was lymphoid malignancy. The septic group included patients with severe inflammation, infection site and organ failure according to the ACCP/SCCM criteria. Median SOFA score is 10.5 (Q1: 5, Q3: 15).
Results: Median ferritin levels (ng/ml) in sHLH and septic patients were 9700 (Q1: 3253, Q3: 17952) and 1314 (Q1: 758, Q3: 4019) respectively. Median S-RP levels (mg/l): 85.3 (Q1: 29, Q3: 161) and 222 (Q1: 143, Q3: 277). Median C-RP/ferritin ratio was 113 (Q1: 58.5, Q3: 364) and 9 (Q1: 2.8, Q3: 23) in sHLH and septic patients respectively. According to ROC-analysis, the area under the curve for ferritin was 0.85, S-RP e 0.73, ferritin/C-RP ratio e 0.93. The cutoff of 15 provides sensitivity 98%, specificity 64%; of 30 e 88% and 83% respectively.
Conclusion: Ferritin/C-RP ratio is a potential new tool for differentiation of sepsis and sHLH. The validation in an independent cohort of patient is needed.
Процитировать:
Titov, Aleksei & Potapenko, Vsevolod & Pervakova, Margarita & Lapin, Sergey & Klimovich, Anna & Pavluchenko, Elena & Karev, Vadim & Potikhonova, Nadejda & Medvedeva, Nadejda. (2019). Ferritin/C-Reactive Protein Ratio is Useful in Distinguishing Secondary Hemophagocytic Lymphohisteocytosis and Sepsis. Clinical Lymphoma Myeloma and Leukemia. 19. S351. 10.1016/j.clml.2019.07.365.