Clinical features and prognosis of elderly patients with hemophagocytic syndrome
Objective To investigate the clinical features,responses to treatments,and prognosis of elderly patients with hemophagocytic syndrome(HPS)and to provide evidence for clinical management.Methods The enrolment included a cohort of 38 eligible patients with HPS admitted to the Department of Emergency of Peking University People's Hospital between September 2019 to August 2021.Patients were divided into an elderly group(≥65 years old)and a non-elderly group(＜65 years old)based on age and also divided into a death group and a survival group based on prognosis.Medical records included clinical conditions,a complete blood count,a blood chemistry panel,coagulation function tests,serum ferritin,natural killer cell activity,soluble interleukin-2 receptor levels,and other clinical tests at admission.A complete blood count,a blood chemistry panel,coagulation function tests and other clinical assessments were conducted at day 7 after treatment.The clinical features of elderly patients with HPS and risk factors affecting prognosis were summarized and discussed.Results Compared with patients under 65 years of age,the proportion of elderly HPS patients with altered consciousness was higher and the in-hospital mortality was markedly higher(especially in elderly patients with infectious disease-related HPS).A review of post-treatment data revealed that elderly patients with HPS had worse therapeutic responses.Patients in the death group were significantly older than those in the survival group.The receiver operating characteristic curve for predicting in-hospital mortality at 67.5 years of age had a sensitivity of 73.3％and a specificity of 69.6％,with the area under the curve at 0.822(0.689-0.955,P=0.001).Multivariate Logistic regression analysis showed that the OR value of age for the risk assessment of death in HPS patients was 1.096(95％CI:1.013-1.185,P=0.022).Kaplan-Meier curve analysis showed that elderly patients(≥65 years)with HPS had an increased risk of death by 60 days(P=0.036).Conclusions Elderly patients with HPS have more severe clinical manifestations,are more prone to consciousness disorders,have worse therapeutic responses and prognosis,and should be given more attention in clinical practice.
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