Ferritin index is a strong prognostic marker in adult hemophagocytic lymphohistiocytosis

Aims The relationship between ferritin levels and survival in adult hemophagocytic lymphohistiocytosis (HLH) has been evaluated in previous studies. However, Admission-to-discharge percentage ferritin reduction (named as ferritin index) level in adult patients with HLH has never been evaluated to predict 6-month survival. Methods The demographic, laboratory and clinical information of 102 newly diagnosed adult HLH patients were collected. Regression analysis, receiver operating curve and Kaplan-Meier curves were analysed to explore the performance of ferritin levels. Results Ferritin index and discharge ferritin level were significantly different between survivour and non-survivour group (allP < .001). Ferritin index had the highest area under the curve (AUC) for predicting the survival (AUC = 0.802,P < .001) followed by discharge ferritin (AUC = 0.746,P < .001). Kaplan-Meier analysis showed a significant difference in survival according to optimum cutoff values of ferritin index >= 10.19% (P < .001) or discharge ferritin <= 1056.1 mu g/L (P < .001). Multivariate analysis confirmed that ferritin index and discharge ferritin are independent predictors of 6-month survival (ferritin index: odds ratio (HR) 6.237, 95% confidence interval (CI) 2.075-18.774,P = .001; discharge ferritin: HR 6.024, 95% CI 1.894-19.231,P = .002). In addition, the combination of a ferritin index >= 10.19% and discharge ferritin <= 1056.1 mu g/L had a significantly higher 6-month survival (P < .001). Conclusion Ferritin index is a better predictor of 6-month survival than admission and discharges ferritin levels in adult patients with HLH.