Prognostic factors of early death in children with hemophagocytic lymphohistiocytosis

Hemophagocytic lymphohistiocytosis is a rapidly progressing and fatal disease. Early identification of early death for HLH patients based on the laboratory findings at the time of diagnosis could improve the overall survival. A retrospective study was performed on 95 Chinese pediatric patients with HLH. Patients' data including clinical features and laboratory findings at diagnosis were collected. In a multivariate Cox proportional hazard regression model analysis, albumins <= 27.75 g/L (hazard ratio (HR) = 11.82, 95% confidence interval (CI) 2.58-54.23; P = 0.001), LDH >= 3707.5 U/L (HR = 4.15, 95%CI 1.43-12.01; P = 0.009), and IL-10 >= 456 pg/ml (HR = 12.39, 95%CI 1.59-96.79; P = 0.016) at diagnosis were independent prognostic factors of early death. The risk of early death was 33-fold increase in patients with three risk factors (HR = 33.33; 95%CI 8.40-125.00; P < 0.001), and 12-fold increase in patients with two risk factors (HR = 12.80; 95%CI 2.34-69.80; P = 0.002) when compared to it in patients with zero to one risk factor. Our results reveal that HLH patients with the risk of early death can be identified by laboratory findings at diagnosis, which may help guide the treatment decision making for this disease.