The Relationship Between The Levels Of SF,FIB And The Early Diagnosis And Prognosis Of Hemophagocytic Syndrome

Objective:To explore the early diagnosis and prognosis of serum ferritin(SF)and fibrinogen(FIB)with Hemophagocytic lymphohistiocytosis(HLH)in children.Methods:From January 2014 to December 2018 in Kunming Children’s Hospital,select 127 hospitalized children with initial diagnosed HLH(HLH group).Randomly select 127 children who were treated in our hospital in the same period and excluded HLH diagnosis as the contrast person(control group).Record the sex,age and etiology of the child,Venous blood samples were taken from children in HLH group and control group on the day of treatment,and in HLH group during the course of disease to detect SF and FIB.Telephone follow-up on the survival status of children within one year,according to the outcome of HLH group,the patients were divided into survival group(n=89)and death group(n=38),and record the dynamic changes of SF and FIB levels during treatment,and the time it takes for SF to rise to the highest value and FIB to fall to the lowest value,to evaluate its value in early diagnosis and prognosis of HLH.The predicted value was obtained by using the binary logistic model,and the predicted value was used as a test variable to draw a ROC curve together with the gold standard to analyze the sensitivity and specificity of SF,FIB and their combination in the early diagnosis of HLH,and to analyze the correlation between the dynamic changes of SF and FIB levels and the prognosis of children with HLH.Results:(1)There was no significant difference in sex and age between the HLH group and the control group,survival subgroup and death subgroup(P>0.05).It can be considered that the consistency between the two was good,so there was comparability among the groups.(2)For the first time,the SF value of the HLH group was significantly higher than that of the control group,while the FIB value was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).(3)The areas under the ROC curve of SF,FIB and their combination in the diagnosis of HLH were 0.874,0.796 and 0.909 respectively.The best cut-off values of SF and FIB for individual diagnosis of HLH were>854ug/L and ≤1.77g/L,respectively,the corresponding sensitivities were 71.7%and 68.5%,respectively,the specificity was 92.9%and 83.5%,and the accuracy was 82.3%and 76.0%,respectively.The best cut-off values for early diagnosis of HLH with SF+FIB were>1526ug/L and ≤ 3.32g/L,respectively,the sensitivity,specificity and accuracy were increased to 76.4%,96.1%and 86.3%,respectively.(4)The SF and FIB levels detected at the first admission show no significant difference between the death group and the survival group(P>0.05).After treatment,the SF level of children in the death group was significantly higher than that in the survival group,while the FIB level of children in the death group was significantly lower than that in the survival group,with statistically significant differences(P<0.05).(5)In the death group,the SF level after treatment was significantly higher than that before treatment,and the level of FIB after treatment was significantly lower than that before treatment,with statistically significant differences(P<0.05).In the survival group,the SF level after treatment was significantly lower than that before treatment,and the level of FIB after treatment was significantly higher than that before treatment,with statistically significant differences(P<0.05).(6)The time required for SF level to reach the highest value in the dying group was significantly shorter than that in the survival group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the time it took for FIB to reach the minimum between the survival and death groups(P>0.05)(7)Observe the highest SF value and the lowest FIB value during treatment to evaluate their relationship with the prognosis of HLH.The AUC of the highest value of SF,the lowest value of FIB and the combination of the two to evaluate the prognosis of HLH were 0.783,0.700 and 0.724,respectively,the best cut-off values of SF and FIB for evaluating the prognosis of HLH were>3853ug/L and ≤ 0.95g/L,respectively,the corresponding sensitivities were 81.6%and 60.5%,respectively,the specificity was 70.8%and 70.8%,respectively,the accuracy was 74.0%and 67.7%respectively;The best cut-off values for the combination of the highest value of SF and the lowest value of FIB were>20000ug/L and ≤ 1.06g/L,respectively,the sensitivity,specificity and accuracy were 57.9%,80.9%and 74.0%,respectively.(8)During the 12-month follow-up period,survival analysis of 127children with HLH showed that the overall survival rate was 70.1%,after discovery and diagnosis 1 to 3 months,the survival rate decreased from 81.9%to 74.0%.After that,the survival curve of children with HLH tends to be flat.Conclusion:(1)The determination of SF and FIB levels can provide a basis for early diagnosis of HLH.SF has good clinical diagnostic value for HLH.But compared with any one of SF and FIB,combined detection of SF and FIB was helpful to improve the specificity,sensitivity and accuracy of early diagnosis of HLH.(2)The levels of SF and FIB in children with HLH changed dynamically during treatment.The detection of SF or FIB alone for the first time on admission was a little of significance in evaluating the prognosis of HLH.However,the dynamic changes of SF and FIB were different in children with different severity of HLH.The higher the level of SF or the lower the level of FIB,may be associated with the poor prognosis of children with HLH.That was to say,to a certain extent,it can evaluate the severity of the disease of children with HLH.