Characteristics of patients
A total of 92 patients were included in our analysis, the median age at diagnosis of them was 50 years, ranged from 16-88, and 54 patients (58.6%) were male.
Regarding the triggering condition, 48 patients (52.2%) secondary to malignancy, 27 patients (29.3%) secondary to infections, 10 patients (10.9%) secondary to autoimmune disorders, and the underlying triggering disease of 7 patients (7.6%) were unknown. In addition, we analyzed the triggering condition according to age and gender, malignancy was the mainly triggering condition in all subgroup, the distribution was shown in Figure 1.
51 patients (55.4%) received only glucocorticoid therapy, 32 patients (34.8%) received glucocorticoid combined with etoposide, and 9 patients (9.8%) did not receive any special treatment for hemophagocytic syndrome and were only treated with supportive symptomatic treatment.
Patients Characteristics according to survival status and NLR
After diagnosis and initial treatment, all patients were followed up for at least 30 days. In our cohort, 39 patients died with a mortality of 42.3% after 30 days of observation. Patients were divided into two groups according to survival status, and the patient’s characters, complete blood counts, NLR, biochemical indicators, and underlying triggering condition were compared. There was significant difference in age, lymphocyte counts, NLR, PLT, PT, APTT, FIB, Albumin, Creatinine, LDH, and splenomegaly (Table 1). Nonsurvivor were associated with elder(P=0.04), lower lymphocyte counts (P=0.001), lower PLT counts (P=0.019), lower FIB level (P=0.024), lower albumin level (P=0.008), higher NLR (0.005), longer PT level (P=0.005), longer APTT level (0.002), higher creatinine level (P=0.017), higher LDH level (P=0.035) and splenomegaly (P=0.02), respectively.
Furthermore, patients were also divided into two groups according to NLR median value, and higher NLR was correlated with older age (P=0.020), worse survival status (P=0.006), lower HB level (P=0.008), longer PT level (P=0.010), higher creatinine level (0.027) and higher IL-6 level (P=0.008) (Table 1), in addition, NLR were correlated with the length of survival (spearman correlation=-0.252, P= 0.016).
Univariate analysis for 30-day-mortality
To further identify the potential indicators, cox regression was employed to identify the potential prognosis factors for 30-day-mortality. As shown in Table 2, L≥0.62×109/L (HR=0.427, 95%CI:0.219-0.833), NLR≥2.99 (HR:2.396, 95%CI:1.230-4.669), PT≥13.3s (HR:2.620, 95%CI:1.303-5.269), APTT≥39.5s (HR:2.701, 95%CI:1.366-5.340) and albumin≥26 g/L (HR:0.346, 95%CI: 0.175-0.685) could be used as prognostic factors for 30-day-mortality.
Multivariate analysis for 30-day-mortality
In multivariate analysis, NLR≥2.99 (HR=2.508, 95%CI: 1.275-4.934) and APTT≥39.5s (HR=2.780, 95%CI: 1.395-5.542) were associated with a poorer prognosis, albumin ≥26g/L (HR=0.384, 95%CI: 0.192-0.768) was associated with a better prognosis, and could be used as independent predictors for 30-day-mortality (Table 3). In addition, the Kaplan-Meier curve according to NLR, APTT, and albumin were shown in figure 2.