International Journal of General Medicine (Aug 2021)
Clinical Characteristics of Adult Hemophagocytic Lymphohistiocytosis in the Emergency Department
Abstract
Fang-Jie Zhang, Guo-Qing Huang, Jia Li, Ji Xu, Xiang-Min Li, Ai-Min Wang Department of Emergency Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of ChinaCorrespondence: Xiang-Min Li; Ai-Min WangDepartment of Emergency Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of ChinaTel +8613875858068; +8613875927399Email [email protected]; [email protected]: To determine the clinical manifestations and results of adult hemophagocytic lymphohistiocytosis (HLH) patients in our emergency department.Methods: We retrospectively evaluated patients with HLH from 1 April 2018 to 31 December 2020. The clinical data of these patients (basic information, symptoms, vital signs, laboratory results, HLH diagnostic criteria, H Score, main treatments, outcomes) were collected.Results: Thirty-three patients (23 males and 10 females; 40.55± 18.78 years) with 34 clinical episodes (one male had two clinical episodes and died during the second episode) were enrolled. Twenty-five patients were placed in a “survivor” group, and nine patients were categorized into a “deceased” group. Fever, splenomegaly, hemoglobin < 90 g/L and platelet count < 100× 109/L most commonly met the diagnostic standard for HLH. The H Score results in the survival group and deceased group was 212.4± 37.18 and 252.1± 40.95, respectively. Viral infection was the most common reason for HLH, followed by immune-system disease and cancer. Laboratory tests showed that deceased-group patients had multiple-organ dysfunction. Multivariate logistic regression showed that the lactate dehydrogenase (lactate dehydrogenase) level (P = 0.039; odds ratio, 0.999) was significantly related to death.Conclusion: In the emergency department, HLH should be considered for critically ill patients with fever, splenomegaly, low hemoglobin and low platelet count. The H Score might be useful to diagnose HLH quickly. In our study, 26.47% of HLH patients died in the emergency department, and patients with a significantly increased lactate dehydrogenase level had a markedly increased risk of death.Keywords: clinical characteristics, hemophagocytic lymphohistiocytosis, emergency department, mortality, lactate dehydrogenase
