Ferritin index is a strong prognostic marker in adult hemophagocytic lymphohistiocytosis.

Abstract

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. 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. Ferritin index and discharge ferritin level were significantly different between survivour and non-survivour group (all P<.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≤1056.1μg/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≤1056.1μg/L had a significantly higher 6-month survival (P<.001). Ferritin index is a better predictor of 6-month survival than admission and discharges ferritin levels in adult patients with HLH.