Dengue infection complicated by hemophagocytic lymphohistiocytosis: Experiences from 180 severe dengue patients
2019
BACKGROUND: Globally approximately 500,000 people with severe dengue (SD) require hospitalization yearly; about 12,500 (2.5%) die. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially fatal hyperinflammatory condition for which HLH-directed therapy (as etoposide and dexamethasone) can be life-saving. Prompted by the high mortality in SD and the increasing awareness that patients with SD may develop sHLH, our objectives were to i) determine the frequency of dengue-HLH in SD, ii) describe clinical features of dengue-HLH, iii) assess mortality rate in SD and dengue-HLH, and iv). identify mortality-associated risk factors in SD. METHODS: A 5-year retrospective single-center study on all adult patients with SD admitted to a tertiary ICU in Malaysia. RESULTS: Thirty-nine/180 (22%) patients with SD died. Twenty-one/180 (12%) had HLH defined as HLH-probability ≥70% according to HScore; nine (43%) died. Similarly, 12/31 (39%) fulfilling ≥4 and 7/9 (78%) fulfilling ≥5 HLH-2004 diagnostic criteria died. Peak values of AST, ALT, LDH, and creatinine correlated to fatality (OR=2.9, 3.4, 5.8, and 31.9; all p<0.0001), as did peak ferritin (OR=2.5, p=0.0028), nadir platelets (OR=1.9, p=0.00068), hepatomegaly (OR=2.9, p=0.012), and increasing age (OR=1.2, p=0.0043). Multivariable logistic regression revealed peak AST (OR=2.8, p=0.0019), peak creatinine (OR=7.3, p=0.0065), and SOFA score (OR=1.4, p=0.0051) as independent risk factors of death. CONCLUSIONS: Be observant of dengue-HLH due to its high mortality. A prospective study is suggested on prompt HLH-directed therapy in SD patients with hyperinflammation and evolving multi-organ failure at risk of developing dengue-HLH.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
35
References
15
Citations
NaN
KQI