Ferritin index is a strong prognostic marker in adult hemophagocytic lymphohistiocytosis

Xiang

et al. 2021

Preprint

Objectives: To describe the prognostic factors of adult patients diagnosed with secondary hemophagocytic lymphohistiocytosis (HLH), a rare disease caused by excessive immune activation and uncontrolled cytokine storm, and to establish and initially validate the predictive value of a prognostic model.Methods: We conducted a retrospective cohort study of 204 adult secondary HLH patients from January 2010 to December 2018 (the development cohort, n=161) and January 2019 to December 2020 (the validation cohort, n=43). All patients met ≥5 HLH-2004 criteria. Prognostic variables to death within three months at diagnosis were selected by logistic regression models, and performance of the predictive model was assessed in development and validation cohort, respectively.Results: Of all patients, malignancies were the most common trigger, accounting for 61.3%. Patients with poor prognosis showed lower hemoglobin (P<0.001), platelets (P<0.001), albumin (P=0.007) and fibrinogen (P=0.002), and higher levels of total bilirubin (P=0.007), LDH (P=0.033), BUN (P=0.006), and TG (P=0.015). Furthermore, patients with poor prognosis had a higher ISTH score (P<0.001). In the development cohort, a predictive model was established based on four variables (splenomegaly, hemoglobin, LDH and ISTH score) recognized by the multivariate logistic regression, with the cut-off value of 0.277 reaching a sensitivity of 87.7%, specificity of 49.0% and AUC of 0.731 (95%CI 0.651-0.810, P<0.001). Besides, the model could perform well in the validation cohort, with a sensitivity of 53.8%, specificity of 40.0% and accuracy of 44.2%.Conclusions: Our predictive model provides a possibility of forecasting the prognosis of adult patients within three months at diagnosis of secondary HLH, while more large sample, multicenter, randomized controlled clinical research are needed to confirm it.

Section: Discussionsupporting

confidence: 86%

Development and Initial Validation of a Novel Prognostic Model in Adult Secondary Hemophagocytic Lymphohistiocytosis Patients: Experience From a Single-center Retrospective Study

Xiang

et al. 2021

Preprint

“…In contrast to previous studies, this paper focuses on the predictive value of ferritin for induction response in patients with HLH. Previous investigators have discussed the relationship between ferritin and the prognosis of patients at six months, one year and two years after treatment and conclude that serum ferritin is a good predictor of survival [ 21 , 22 ]. Our study also analysed the predictive role of ferritin on survival, and the results showed significant differences in survival among patients with different ferritin stratification at three to four weeks after induction therapy.…”

Section: Discussionmentioning

confidence: 99%

Serum ferritin is a good indicator for predicting the efficacy of adult HLH induction therapy

Hua

Zhang

et al. 2022

Annals of Medicine

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare clinical syndrome with a high mortality rate. There is no biomarker to predict the early therapeutic response. Objective: Our study explores the significance of serum ferritin in predicting the response of induction therapy. Methods: We retrospectively analyzed the clinical data of 102 adult patients with HLH admitted to our hospital. These patients received HLH-94 regimen for induction therapy. The patients were divided into remission group and non-remission group according to the response of induction therapy. Results: Ferritin values between 1–4 weeks post induction were predictive of remission ( p <.05), which were higher in the non-remission group than in the remission group. Ferritin obtained 2 weeks post-induction had the highest ROC for predicting remission, with a cut-off value of 1188.5 µg/L. And patients with ferritin lower than 1188.5 µg/L had better response of induction therapy. Conclusion: Our study suggests that serum ferritin is a good indicator to predict the efficacy of induction therapy for adult HLH. KEY MESSAGES Serum ferritin is a good indicator for predicting the efficacy of adult HLH induction therapy. Serum ferritin two weeks after treatment may be a better indicator to judge the early curative effect. Serum ferritin after treatment also had a predictive significance for the survival of HLH.

Saudi Journal of Biological Sciences

“…( Ghoneum et al, 2019 Apr );( Dignass et al, 2018 Mar ) ;( Lee et al, 2019 ) ;( Knaak et al, 2020 Jun 1 ) ;( Zhou et al, 2021 Mar ) ;( Worth et al, 2020 May ) ;( Martin-Bastida et al, 2017 May 3 ) ;( WHO international coronavirus disease (COVID-19) situation reports. Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-, 2021 ) ;( Dave et al, 2021 Sep ) ;( Waizel-Haiat et al, 2021 Feb ) ;( Banerjee et al, 2021 Jun 7 ) ;( Cavezzi et al, 2020 May ) ;( Pongtanakul et al, 2017 Jun 19 ) ;( Birlutiu et al, 2021 ) .…”

Section: Uncited Referencesmentioning

confidence: 99%

Therapeutic potential of induced iron depletion using iron chelators in Covid-19

Naseef

Elayadeth-Meethal

et al. 2022

Ferritin, which includes twenty-four light and heavy chains in varying proportions in different tissues, is primarily responsible for maintaining the body's iron metabolism. Its normal value is between 10 and 200 ngmL -1 in men and between 30-300 ngmL -1 in women. Iron is delivered to the tissue via them, and they act as immunomodulators, signaling molecules, and inflammatory markers. When ferritin level exceeds 1000 µgL -1 , the patient is categorized as having hyperferritinemia. Iron chelators such as deferiprone, deferirox, and deferoxamine are currently FDA approved to treat iron overload. The inflammation cascade and poor prognosis of COVID-19 may be attributed to high ferritin levels. Critically ill patients can benefit from deferasirox, an iron chelator administered orally at 20-40 mgkg -1 once daily, as well as intravenous deferoxamine at 1000 mg initially followed by 500 mg every 4 to 12 hours. It can be combined with monoclonal antibodies, antioxidants, corticosteroids, and lactoferrin to make iron chelation therapy effective for COVID-19 victims. In this article, we analyze the antiviral and antifibrotic activity of iron chelators, thereby promoting iron depletion therapy as a potentially innovative treatment strategy for COVID-19.