title: Hemophagocytic Lymphohistiocytosis in Intensive Care Unit: A 71-Case Strobe-Compliant Retrospective Study.
abstract: Hemophagocytic lymphohistiocytosis (HLH) is a critical condition that may lead to organ failure and early death. The aim of this retrospective observational study was to describe a cohort of HLH patients admitted to intensive care unit (ICU) and investigate the risk factors of early death.A positive HLH diagnosis was defined by an HScore ≥ 169. Univariate and multivariate analyses were carried out to investigate hospital and 28-day mortality risk factors. Between January 2002 and July 2014, 71 HLH cases were seen at our institution.The overall 28-day mortality (start at ICU admission) and hospital mortality were 38% and 68%, respectively. The factors associated with increased 28-day mortality were the sequential organ failure assessment score at ICU admission (P < .001) and advance in age (P = 0.03). The factors associated with increased hospital mortality were a high sequential organ failure assessment score at ICU admission (P < 0.01), advance in age (P = 0.04), and the presence of lymphoma-related HLH or HLH of unknown origin (P < 0.01).Organ failure overtops the classical early-death risk factors in adult ICU-admitted HLH patients. This failure and the subsequent early death may be prevented by timely specific cytotoxic therapies and the control of the underlying disease.
authors.affiliation: From the Hospices Civils de Lyon, Department of Internal Medicine, Croix-Rousse University Hospital, Lyon; Université Lyon I, Villeurbanne (TB, CB, YJ, PS); Hospices Civils de Lyon, Service de Biostatistique, Lyon; CNRS UMR 5558, Equipe Biostatistique-Santé, Pierre-Bénite; Université Lyon I, Villeurbanne (DM-B, JI); Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre-Bénite; Université Lyon I, Villeurbanne (JB); Hospices Civils de Lyon, Department of Internal Medicine, Edouard Herriot University Hospital, Lyon; Université Lyon I (JN, AH); Hospices Civils de Lyon, Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre-Bénite; Université Lyon I (JCL); Hospices Civils de Lyon, Intensive Care Unit, Croix-Rousse University Hospital, Lyon; Université Lyon I, Villeurbanne (CG, JCR); and Hospices Civils de Lyon, Intensive Care Unit, Edouard Herriot University Hospital, Lyon; Université Lyon I, Villeurbanne, France (LA).
authors.forename: Thomas
authors.initials: T
authors.lastname: Barba
authors.forename: Delphine
authors.initials: D
authors.lastname: Maucort-Boulch
authors.forename: Jean
authors.initials: J
authors.lastname: Iwaz
authors.forename: Julien
authors.initials: J
authors.lastname: Bohé
authors.forename: Jacques
authors.initials: J
authors.lastname: Ninet
authors.forename: Arnaud
authors.initials: A
authors.lastname: Hot
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lega
authors.forename: Claude
authors.initials: C
authors.lastname: Guérin
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.forename: Christiane
authors.initials: C
authors.lastname: Broussolle
authors.forename: Yvan
authors.initials: Y
authors.lastname: Jamilloux
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Richard
authors.forename: Pascal
authors.initials: P
authors.lastname: Sève
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D051359:Lymphohistiocytosis, Hemophagocytic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D012189:Retrospective Studies; D012307:Risk Factors