Clinical Analysis Of 32 Cases Of Adult Infection-associated Hemophagocytic Syndrome

Objective:To analyze the clinical manifestation,laboratory examination and prognosis of adult infection-associated hemophagocytic syndrome.Methods:A retrospectively study was performed to analyze the clinical data of 32 patients with adult infection-associated hemophagocytic syndrome in the First Affiliated Hospital of Kunming Medical University from July 2014 to November 2019.The patients were divided into survival group and death group according to the 28-day prognosis after diagnosis.Meanwhile,The patients were divided into bacteria group and virus group according to the results of pathogen detection.Multivariate Logistic regression analysis was performed on the variables with statistical significance.The receiver operating characteristic curve(ROC)were drawn.Results:Among 32 patients,there were 17 males(53.1%)and 15 females(46.9%),and the overall mortality rate was 62.5%(20/32).Among 32 patients,there were 18 cases in bacterial infection group and 14 cases in virus infection group.?Compared with the survival group,the levels of leucocyte count(WBC)?neutrocyte count(N)?leukomonocyte count(L)?platelet count(PLT)and oxygenation index(OI)in death group were decreased,while the levels of aspartate aminotransferase(AST)?lactate dehydrogenase(LDH)?serum ferritin(SF)?plasma potassium(K+)?thermal process(before and after treatment)and the incidence of cyanosis were increased.There was no significant difference in other indicators between the two groups.Multivariate Logistic regression analysis showed that thermal process before treatment,and oxygenation index were risk factors for 28-day mortality of adult infection-associated hemophagocytic syndrome.B value was 0.198 and-0.026 respectively,and the odds ratio(OR)was 1.219 and 0.975 respectively(both P<0.05).It was shown by ROC curve analysis that OI and WBC had better predictive value for 28-day prognosis of adult patients with infection-associated hemophagocytic syndrome(both P<0.01),and the area under ROC curve(AUC)was 0.847[95%CI=0.710?0.984]?0.799[95%CI=0.617?0.981]respectively.When the cut-off of OI was 145.5,the sensitivity was 63.2%,and the specificity was 100%.When the cut-off of WBC was 3.235 X 109/L,the sensitivity was 68.4%,and the specificity was 90.9%.The predictive value of OI and WBC was higher,AUC was 0.904[95%CI=0.787?1.000],the sensitivity was 84.2%,and the specificity was 90.9%.?Compared with the virus group,myoglobin(MYO)in bacteria group was increased,the highest body temperature and the incidence of lymphadenopathy were decreased.There was no significant difference in other indicators between the two groups.Multivariate Logistic regression analysis showed that myoglobin and lymphadenopathy were not risk factors for viral infection of adult infection-associated hemophagocytic syndrome,the highest body temperature was risk factor,? value was 1.830,and the odds ratio(OR)was 6.235(P<0.05).ROC curve analysis showed that the highest body temperature had better predictive value for viral infection of adult infection-associated hemophagocytic syndrome(P<0.01),and the area under ROC curve(AUC)was0.855[95%CI=0.716?0.994].When the cut-off was 39.85?,the sensitivity was 78.6%,and the specificity was 88.9%.Conclusions:Leucocyte count(WBC)?neutrocyte count(N)?leukomonocyte count(L)?platelet count(PLT)?oxygenation index(OI)?aspartic aminotransferase(AST)?lactate dehydrogenase(LDH)?serum ferritin(SF)?plasma potassium(K+)?thermal process and cyanosis were associated with the 28-day prognosis of adult infection-associated hemophagocytic syndrome.Patients with long thermal process before treatment?OI<145.5 and leucocyte count(WBC)<3.235 ×109/L had a poor prognosis.Serum myoglobin,lymphadenopathy and fever heat can be used to distinguish the pathogens of adult infection associated hemophagocytic syndrome.The highest body temperature was over 39.85?,suggesting that pathogens for adult infection-associated hemophagocytic syndrome might be virus.