Journal of Clinical Pediatrics >
Comparison of clinical features between hemophagocytic lymphohistiocytosis and sepsis
Received date: 2023-11-17
Online published: 2024-06-07
Objective To compare the clinical features of hemophagocytic lymphohistiocytosis (HLH) and sepsis, and to find laboratory markers to help differential diagnosis. Methods The clinical data of HLH children without underlying disease or sepsis children with fever and decreased peripheral blood two cell lines or splenomegaly from January 2013 to December 2020 was retrospectively analyzed. Results A total of 106 patients were enrolled in this study. There were 72 children (46 boys and 26 girls) in the HLH group, and the median age was 26.5 (14.3-56.8) months. There were 34 children (18 boys and 16 girls) in the sepsis group, and the median age was 14.0 (3.8-89.0) months. The total length of hospital stay and PICU stay in the sepsis group were longer than those in the HLH group, and the differences were statistically significant (P<0.05). Compared with the sepsis group, the white blood cell count (WBC)-Min, absolute neutrophil count (ANC)-Min, hemoglobin (HB)-Min, platelet count (PLT)-Min, creatinine (CREA)-Max, fibrinogen (FIB)-Min, C-reactive protein (CRP)-Max, and procalcitonin (PCT)-Max were lower, and triglyceride-Max and serum ferritin (SF)-Max were higher in the HLH group. The duration of HB reduction was shorter in the HLH group, while the duration of ANC reduction was longer, and the differences between the two groups were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the decreased levels of WBC-Min, FIB-Min, CREA-Max and PCT-Max were helpful for the diagnosis of HLH (P<0.05). The AUC of SF-Max to aid in the diagnosis of HLH was 0.72 (95%CI: 0.62-0.80), according to ROC curve analysis. The combined predictors of WBC-Min, FIB-Min, CREA-Max and PCT-Max were obtained by logistic regression equation fitting, and the AUC of which in the diagnosis of HLH was 0.95 (95%CI: 0.89-0.99). The AUC of the combined predictors was significantly larger than that of SF-Max, and the difference was statistically significant (P<0.01). Conclusions The fitting of WBC-Min, FIB-Min, CREA-Max and PCT-Max may help to better distinguish HLH from sepsis.
Xiaomei ZHONG , Hong REN , Jian ZHANG , Biru LI , Juan QIAN , Botao NING , Yijin GAO , Ying WANG . Comparison of clinical features between hemophagocytic lymphohistiocytosis and sepsis[J]. Journal of Clinical Pediatrics, 2024 , 42(6) : 547 -552 . DOI: 10.12372/jcp.2024.22e1731
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