Johnson Benny, Giri Smith, Nunnery Sara E, Wiedower Eric, Jamy Omer, Yaghmour George, Chandler Jason C, Martin Mike G
Division of Hematology/Oncology, Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN.
Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN.
Clin Lymphoma Myeloma Leuk. 2016 Apr;16(4):230-6. doi: 10.1016/j.clml.2016.01.002. Epub 2016 Jan 12.
Secondary hemophagocytic syndrome (SHPS) is a syndrome that develops as a result of infection, autoimmunity, or underlying malignancy. We studied novel predictors of mortality among adults with SHPS.
SHPS were identified from the Nationwide Inpatient Sample for 2009 to 2011 using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes. Charlson comorbidity index (CCI) was used for comorbidity assessment, excluding malignancy. Patient- and hospital-related factors on mortality were assessed by chi-square test or analysis of variance. P values were 2 sided, and the level of significance was .05.
A total of 276 patient hospitalizations with SHPS were identified. Forty-four had an associated malignancy, 38 (86%) of which were hematologic. Median age was 42 years (range, 18-89 years). A total of 66% (n = 182) had a CCI of 0, 13% (n = 27) had a CCI of 1, and 21% (n = 57) had a CCI of 2 or more. On bivariate analysis, inpatient mortality rate was significantly higher in malignancy-associated hemophagocytic syndrome (HPS) (odds ratio [OR], 2.07; P = .04), age ≥ 50 years (OR, 3.46; P < .01), CCI ≥ 2 (OR, 3.04; P < .01), and Medicare patients (OR, 2.32; P < .01). In multivariate analysis, CCI ≥ 2 remained an independent predictor of survival in the overall study cohort (OR, 3.52; 95% confidence interval, 1.51-8.18; P < .01).
Malignancy-associated HPS, CCI ≥ 2, age > 50 years, and Medicare patients were associated with a worse in-hospital mortality. In multivariate analysis, greater comorbidity burden appeared to be the single most important predictor of mortality. This suggests that outcomes for adults with HPS are predicated by the extent of organ dysfunction at diagnosis.
继发性噬血细胞综合征（SHPS）是一种因感染、自身免疫或潜在恶性肿瘤而引发的综合征。我们研究了成年SHPS患者死亡的新预测因素。
利用国际疾病分类第九版临床修订本（ICD - 9 - CM）编码，从2009年至2011年全国住院患者样本中识别出SHPS。采用Charlson合并症指数（CCI）进行合并症评估，不包括恶性肿瘤。通过卡方检验或方差分析评估患者及医院相关的死亡因素。P值为双侧，显著性水平为0.05。
共识别出276例SHPS患者住院病例。44例伴有相关恶性肿瘤，其中38例（86%）为血液系统恶性肿瘤。中位年龄为42岁（范围18 - 89岁）。共有66%（n = 182）的CCI为0，13%（n = 27）的CCI为1，21%（n = 57）的CCI为2或更高。在双变量分析中，恶性肿瘤相关噬血细胞综合征（HPS）的住院死亡率显著更高（比值比[OR]，2.07；P = 0.04），年龄≥50岁（OR，3.46；P < 0.01），CCI≥2（OR，3.04；P < 0.01），以及医疗保险患者（OR，2.32；P < 0.01）。在多变量分析中，CCI≥2仍是整个研究队列生存的独立预测因素（OR，3.52；95%置信区间，1.51 - 8.18；P < 0.01）。
恶性肿瘤相关HPS、CCI≥2、年龄>50岁以及医疗保险患者与住院死亡率较差相关。在多变量分析中，更大的合并症负担似乎是死亡率的单一最重要预测因素。这表明HPS成年患者的预后取决于诊断时器官功能障碍的程度。
