Clinical Features and Prognostic Factors of Acute Kidney Injury Caused by Adult Secondary Hemophagocytic Lymphohistiocytosis

Abstract

Background and Aims: Hemophagocytic lymphohistiocytosis (HLH ) is a clinical syndrome caused by a cytokine storm and phagocytosis of blood cells. Acute kidney injury (AKI) is typically associated with a poor prognosis in HLH. In the present study, a retrospective analysis of patient data was performed to identify risk factors associated with HLH-induced AKI. Method: All patients were diagnosed with HLH between January 2009 and July 2019. HLH was diagnosed according to the HLH-2004 criteria and AKI was diagnosed according to the Kidney Disease Improving Global Outcomes guidelines, which were last updated in 2012. We collected the general information of the patients, clinical manifestations, treatments, as well as laboratory data from the electronic medical records. Results: We analyzed 600 patients with HLH in the present study. Serum phosphorus levels, administration of vasopressor, heart failure, gastrointestinal symptoms, disseminated intravascular coagulation, high admission heart rate, total bilirubin levels and albumin levels were independently associated with an increased risk of developing AKI. Independent risk factors for in-hospital mortality in patients were administration of vasopressor, AKI stage III, baseline Cystatin-C levels, total bilirubin levels, number of days of glucocorticoid therapy, fibrinogen and multi-organ failure. Interpretation: Patients with HLH usually exhibit a high rate of hospital mortality, particularly when combined with AKI. The risk factors for the occurrence of AKI and increased mortality identified in the present study may assist clinicians in the early prevention of the disease, and in the treatment of HLH-induced AKI, to improve the prognosis of patients. Funding: This work is financially supported by grants from Sichuan Provincial Science and Technology Key R & D Projects [No. 2017SZ0113, No. 2017SZ0144 and No. 2019YFS0282], 1·3·5 project for disciplines of Excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University [NO.2020HXFH049]. Declaration of Interest: None to declare. Ethical Approval: Ethical approval for the present study was obtained from The Ethical Committee of West China Hospital, Sichuan University. As we collected clinical data for retrospective analysis, the Ethics Committee waived the need for informed consent.