Copyright
©The Author(s) 2018.
World J Crit Care Med. Nov 30, 2018; 7(6): 73-83
Published online Nov 30, 2018. doi: 10.5492/wjccm.v7.i6.73
Published online Nov 30, 2018. doi: 10.5492/wjccm.v7.i6.73
Table 1 Descriptive statistics of 16 intensive care unit patients with hemophagocytic Lymphohistiocytosis [expressed as median (IQR)] n (%)
| Parameter | Value |
| Age (yr) | 49 (26-61) |
| Sex | |
| Male | 10 (63) |
| Female | 6 (37) |
| SOFA score on ICU admission | 10 (7-15) |
| Time from hospital to ICU admission | 0.5 (0-7) |
| Time to diagnose HLH (d) | 3 (1-7) |
| Immunodeficiency | 11 (69) |
| HIV infection | 2 |
| Malignancy | 7 |
| Autoimmune (SLE, autoimmune hemolytic anemia) | 2 |
| Precipitating factors | |
| Infection only | 5 (31) |
| Pneumonia | 2 |
| EBV | 2 |
| Typhoid fever | 1 |
| Malignancy only | 2 (13) |
| Diffuse large B cell lymphoma | 1 |
| T cell lymphoma | 1 |
| Infection and malignancy combined | 5 (31) |
| EBV and plasmablastic lymphoma | 1 |
| EBV and Hodgkin lymphoma | 1 |
| EBV and diffuse large B cell lymphoma | 1 |
| EBV and NK cell leukemia | 1 |
| EBV associated lymphoproliferative disorder | 1 |
| Idiopathic | 4 (25) |
| Number of HLH criteria met | 5 (5-6) |
| Principal reason for ICU admission | |
| Severe sepsis/septic shock | 9 (56) |
| Acute respiratory failure | 4 (25) |
| GI Bleed | 2 (13) |
| Acute encephalopathy | 1 (6) |
| ICU length of stay (d) | 11.5 (5-29) |
| Hospital length of stay (d) | 29 (17-40) |
| Prior history of HLH | 3 (19) |
| Biopsies performed | 23 |
| Bone marrow | 13 |
| Liver | 4 |
| Lymph node | 3 |
| Skin | 2 |
| Lung | 1 |
| Bi/pancytopenia on ICU admission | 10 (63) |
| Hemophagocytosis seen on bone marrow biopsy (out of total) | 10 (77) |
| Chemotherapy received | 15 (94) |
Table 2 Laboratory tests in patients with hemophagocytic lymphohistiocytosis [expressed as median (IQR)]
| Laboratory test | Value |
| Hemoglobin on ICU Admission (gm/dL) | 9.3 (8.4-11.35) |
| Lowest Hemoglobin during ICU stay (gm/dL) | 6 (4.4-6.7) |
| Platelet count on ICU admission (K/cubic mm) | 89 (37-159) |
| Lowest platelet count (K/cubic mm) | 7.5 (4-22) |
| White blood cell count on ICU admission (K/microL) | 3.75 (1.75-5.4) |
| Lowest White blood cell count (K/microL) | 0.1 (0.1-0.7) |
| Fibrinogen on ICU admission (mg/dL) | 263 (86-312) |
| Lowest Fibrinogen (mg/dL) | 70 (50-176) |
| First Ferritin level in ICU on clinical suspicion of HLH (microgram/L) | 17728 (7689-37981) |
| Highest ferritin (microgram/L) | 40000 (16500-55000) |
| Triglycerides (mg/dL) | 350 (269-556) |
Table 3 Intensive care unit complications in patients with hemophagocytic lymphohistiocytosis (Total number of patients = 16)
| ICU complications | n (%) |
| Mechanical ventilation | 12 (75) |
| Septic shock | 14 (88) |
| AKI | 13 (81) |
| With renal replacement therapy | 10 |
| Without renal replacement therapy | 3 |
| Acute liver failure | 8 (50) |
| Clinically significant bleeding | 10 (62) |
| GI bleed | 4 |
| Intracerebral bleed | 2 |
| Hemoptysis | 1 |
| Retroperitoneal bleed | 1 |
| Epistaxis | 1 |
| Hematoma-neck | 1 |
| DIC | 9 (56) |
| ARDS | 4 (25) |
| With ECMO | 2 |
| Without ECMO | 2 |
| Pneumonia | 6 (37) |
| Bacterial | 3 |
| Fungal | 3 |
| Viral/others | 0 |
| Acute encephalopathy | 5 (31) |
| Stress cardiomyopathy | 2 (12) |
| Arrythmias (Atrial, ventricular) | 4 (25) |
| Bloodstream infections | 10 (62) |
| Bacteremia | 9 |
| Gram positive organisms | 2 |
| Gram negative organisms | 7 |
| Fungemia | 1 |
| MSOF | 12 (75) |
| Tracheostomy | 3 (19) |
| Mortality | |
| 30 d | 6 (37) |
| 90 d | 13 (81) |
| Miscellaneous (Seizures, perforated viscus, cardiogenic shock requiring IABP, intra-abdominal abscess) | 5 (31) |
Table 4 Differences in mortality based on various categorical variables
| Categorical variable | Categorical variable | P value |
| Age above 50 yr (8 patients) | Age less than or equal to 50 yr (8 patients) | 0.5 |
| SOFA score on ICU admission above 10 (7 patients) | SOFA score on ICU admission less than or equal to 10 (9 patients) | 0.6 |
| Underlying immunosuppression (11 patients) | No underlying immunosuppression (5 patients) | 0.7 |
| Direct admission to ICU (8 patients) | Transfer from floor to ICU (8 patients) | 0.5 |
| Time to diagnose HLH more than 3 d (7 patients) | Time to diagnose HLH less than or equal to 3 d (9 patients) | 0.4 |
- Citation: Kapoor S, Morgan CK, Siddique MA, Guntupalli KK. Intensive care unit complications and outcomes of adult patients with hemophagocytic lymphohistiocytosis: A retrospective study of 16 cases. World J Crit Care Med 2018; 7(6): 73-83
- URL: https://www.wjgnet.com/2220-3141/full/v7/i6/73.htm
- DOI: https://dx.doi.org/10.5492/wjccm.v7.i6.73