Title : Predictive Value of Routine Laboratory Tests for Early Death in Pediatric Hemophagocytic Lymphohistiocytosis Patients
Abstract:
Background:
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening systemic hyperinflammatory syndrome with high early mortality, especially in children. Early risk stratification is critical but hindered by non-routine predictive tests (e.g., sCD25, NK cell activity). This study identifies accessible routine laboratory markers for predicting early death in pediatric HLH, with a focus on novel prognostic value of albumin (ALB).
Methods:
A retrospective analysis of 64 pediatric HLH patients (16 early deaths within 2 months [Group D], 48 survivors >2 months [Group S]) was conducted. Demographic and routine laboratory data were analyzed via Wilcoxon test, LASSO regression (feature selection), and logistic regression (predictive validation).
Results:
Group D patients were predominantly <2 years old (14/16, 87.5%). Univariate analysis linked low RBC, Hb, ALB, FIB, prolonged APTT, and high LDH to early death, with ALB showing the highest AUC (0.97). LASSO and logistic regression confirmed ALB as the only statistically significant routine predictor (P<0.05). The predictive model integrating ALB achieved exceptional performance: AUC near 1.0, with F1 score, sensitivity, specificity, and precision all >0.85.
Conclusion:
This study is the first to highlight ALB as a robust, accessible predictor of early death in pediatric HLH, outperforming other routine markers. Children <2 years old and those with multi-organ involvement are at elevated risk. ALB, a widely available routine test, enables rapid risk stratification—especially valuable in resource-limited settings—filling an unmet clinical need for timely HLH management. These findings refine prognostic strategies and improve targeted interventions for high-risk pediatric HLH patients.
Keywords
hemophagocytic lymphohistiocytosis; early death; routine laboratory tests; albumin; predictor
