is a common, multifactorial, finding in ICU. Hemophagocytosis
is one of the main explanatory mechanisms, possibly integrated into hemophagocytic lymphohistiocytosis
syndrome, of infectious origin in the majority of cases in ICU. The hemophagocytic lymphohistiocytosis
is probably underdiagnosed in the ICU, although it is associated with dramatic outcomes. The main objectives of this work were to identify the frequency of secondary hemophagocytic lymphohistiocytosis
, and the main prognostic factors for mortality.
We conducted a retrospective observational study in all adult patients admitted with suspected or diagnosed hemophagocytic lymphohistiocytosis
, between January 1, 2000, and August 22, 2012.
A total of 106 patients (42%) had significant hemophagocytosis
on bone marrow examination, performed for exploration of thrombocytopenia
, bicytopenia, or pancytopenia.
Measurements and Main Results:
The median age was 56 (45–68) and the median Simplified Acute Physiology Score 2 was 55 (38–68). The main reason for ICU admission was hemodynamic instability (58%), predominantly related to sepsis (45% cases). The main precipitating factor found was a bacterial infection in 81 of 106 patients (76%), including 32 (30%) with Escherichia coli
infection. Forty six of 106 patients (43%) died in the ICU. They were significantly older, had higher Simplified Acute Physiology Score 2, plasma lactate deshydrogenase bilirubin, and serum ferritin
. The fibrinogen and the percentage of megakaryocytes were significantly lower in nonsurvivors when compared with survivors. In multivariate analysis, only serum ferritin
significantly predicted death related to hemophagocytosis
. A serum ferritin
greater than 2,000 μg/L predicted death with a sensitivity of 71% and a specificity of 76%. A decreased percentage of megakaryocytes also predicted patient death in the ICU.
is common in thrombocytopenic patients with sepsis, frequently included in a postinfectious hemophagocytic lymphohistiocytosis
setting. Our study reveals that ferritin
could be a reliable prognostic marker in these patients, and hold particular interest in discussing a specific treatment for hemophagocytic lymphohistiocytosis