Hao Gailing, Geng Wenjin, Li Chunzhen, Li Quanheng, Zhang Nan, Jiang Lian
Department of Emergency Medicine, Hebei Children's Hospital Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China.
Department of Qenal Immunology, Hebei Children's Hospital Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China.
Ann Hematol. 2025 Jan;104(1):111-121. doi: 10.1007/s00277-024-06058-3. Epub 2024 Nov 4.
To analyze the critical factors of infection-associated Hemophagocytic lymphohistiocytosis (HLH) in children, so as to provide theoretical basis for clinicians to evaluate the disease condition, formulate treatment plan and improve prognosis. This study is a retrospective analysis. 60 cases of children with infection-associated HLH were divided into critical and non-critical groups based on the presence of multiple organ dysfunction syndrome (MODS), and the clinical characteristics and laboratory data of the two groups of children were analyzed. A multifactor logistic regression analysis model was used to assess the independent risk factors affecting critical illness in children with infection-associated HLH, and the Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the predictive value of risk factors for critical illness in children with infection-associated HLH. Children in the critical group with HLH had a younger age at onset. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), D-dimer (DD), and triglycerides (TG) were significantly higher in the critical group, while albumin (ALB) was significantly lower, showing statistical significance (P < 0.05). Multifactorial logistic regression analysis of age, ALB, and TG showed that younger age and lower ALB were associated with a higher risk of MODS in children with infection-associated HLH, with age and ALB being independent risk factors for critical illness. ALB predicted the ROC area under the curve for critical children with infection-associated HLH was 0.765 (95% CI: 0.643-0.888, P = 0.011), with the optimal cut-off value being 32.50 g/L (sensitivity = 68.3%, specificity = 84.2%); age predicted the ROC area under the curve for critical children with infection-associated HLH was 0.711 (95% CI: 0.570-0.851, P = 0.009), with the optimal cut-off value being 1.50 years (sensitivity = 70.7%, specificity = 68.4%). This study suggests that younger patients and those with hypoalbuminemia among infection-related HLH patients are more likely to develop MODS. In the future, verification will be required through large-scale, multi-center studies.
分析儿童感染相关性噬血细胞性淋巴组织细胞增生症（HLH）的感染相关关键因素，为临床医生评估病情、制定治疗方案及改善预后提供理论依据。本研究为回顾性分析。将60例感染相关性HLH患儿根据是否存在多器官功能障碍综合征（MODS）分为危重症组和非危重症组，分析两组患儿的临床特征及实验室数据。采用多因素logistic回归分析模型评估影响感染相关性HLH患儿危重症的独立危险因素，并采用受试者工作特征（ROC）曲线分析评估危险因素对感染相关性HLH患儿危重症的预测价值。HLH危重症组患儿发病年龄较小。危重症组患儿的丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、γ-谷氨酰转移酶（GGT）、D-二聚体（DD）及甘油三酯（TG）显著升高，而白蛋白（ALB）显著降低，差异具有统计学意义（P＜0.05）。对年龄、ALB及TG进行多因素logistic回归分析显示，年龄较小及ALB较低与感染相关性HLH患儿发生MODS的风险较高相关，年龄和ALB为危重症的独立危险因素。ALB预测感染相关性HLH危重症患儿的ROC曲线下面积为0.765（95%CI：0.643-0.888，P=0.011），最佳截断值为32.50g/L（灵敏度=68.3%，特异度=84.2%）；年龄预测感染相关性HLH危重症患儿的ROC曲线下面积为0.711（95%CI：0.570-0.851，P=0.009），最佳截断值为1.50岁（灵敏度=70.7%，特异度=68.4%）。本研究提示，感染相关性HLH患者中年龄较小及低白蛋白血症患者更易发生MODS。未来需通过大规模、多中心研究进行验证。
