Department of Hematology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, China.
Department of Hematology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, 100029, China.
Ann Hematol. 2024 Mar;103(3):715-723. doi: 10.1007/s00277-023-05606-7. Epub 2024 Jan 10.
Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome with high mortality rate. The response to induction therapy is an important factor affecting survival. The purpose is to investigate laboratory predictors for induction response in adult patients with HLH, which are convenient, practical, and timeliness. Clinical data from January 2017 to December 2020 was retrospectively analyzed, and 269 patients were included. Patients were divided into remission and non-remission groups according to their induction response, 177 in the remission group, and 92 in the non-remission group. We reviewed general characteristics and analyzed the predictive value of serum ferritin, triglycerides, alanine aminotransferase (ALT), and blood cells before and 1-4 weeks after induction therapy for induction response by univariate analysis, ROC curves, etc. There was a correlation between serum ferritin, ALT, leukocytes, neutrophils, hemoglobin, platelets, and induction response (P < 0.05). Serum ferritin and platelets 1-4 weeks after induction therapy, respectively, might be a good predictor for induction response in adults with HLH, with AUC values close to or greater than 0.7. We established a new clinical model of the ferritin/platelet ratio. The results showed that the ferritin/platelet ratio at 1-4 weeks after induction therapy might be a practical index for predicting induction response, which significantly improved the area under the ROC curve (AUC > 0.75). Patients with a ferritin/platelet ratio > 16.08 at 2 weeks after induction therapy may have a relatively poor induction response. Ferritin/platelet ratio after induction therapy can be a good predictor for induction response in adult patients with HLH.
噬血细胞性淋巴组织细胞增生症（HLH）是一种高死亡率的炎症过度活跃综合征。诱导治疗的反应是影响生存的重要因素。本研究旨在探讨方便、实用、及时的实验室指标预测成人 HLH 患者诱导治疗反应的能力。回顾性分析 2017 年 1 月至 2020 年 12 月的临床资料，共纳入 269 例患者。根据诱导治疗反应将患者分为缓解组和未缓解组，缓解组 177 例，未缓解组 92 例。回顾一般特征，并通过单因素分析、ROC 曲线等方法分析诱导治疗前及治疗后 1-4 周血清铁蛋白、甘油三酯、丙氨酸氨基转移酶（ALT）和血细胞对诱导反应的预测价值。血清铁蛋白、ALT、白细胞、中性粒细胞、血红蛋白、血小板与诱导反应呈正相关（P < 0.05）。诱导治疗后 1-4 周血清铁蛋白和血小板可能是成人 HLH 诱导反应的良好预测指标，AUC 值接近或大于 0.7。我们建立了新的铁蛋白/血小板比值临床模型。结果显示，诱导治疗后 1-4 周铁蛋白/血小板比值可能是预测诱导反应的实用指标，ROC 曲线下面积（AUC）显著提高（AUC > 0.75）。诱导治疗后 2 周铁蛋白/血小板比值>16.08 的患者可能诱导反应较差。铁蛋白/血小板比值可作为预测成人 HLH 患者诱导治疗反应的良好指标。
