Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis
Background. Secondary hemophagocytic syndrome (SHPS) and sepsis, although very similar in their clinical manifestations and laboratory parameters, essentially differ in terms of methods of their treatment. SHPS therapy is aimed at immunosuppression, whereas in sepsis anti-infectious treatment is req...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | Russian |
| Published: |
Practical Medicine Publishing House
2019-05-01
|
| Series: | Клиническая онкогематология |
| Subjects: | |
| Online Access: |
http://bloodjournal.ru/wp-content/uploads/2019/06/12.pdf
|
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850243986299551744 |
|---|---|
| author | VG Potapenko MYu Pervakova AV Titov OV Goloshchapov SV Lapin EA Surkova AV Klimovich OP Mironova NN Petrova NYu Chernookaya EV Karyagina NV Skorobogatova ES Pavlyuchenko EA Karev NA Potikhonova VA Dubkova AYu Kaskov AV Rysev TG Kulibaba NV Medvedeva |
| author_facet | VG Potapenko MYu Pervakova AV Titov OV Goloshchapov SV Lapin EA Surkova AV Klimovich OP Mironova NN Petrova NYu Chernookaya EV Karyagina NV Skorobogatova ES Pavlyuchenko EA Karev NA Potikhonova VA Dubkova AYu Kaskov AV Rysev TG Kulibaba NV Medvedeva |
| author_sort | VG Potapenko |
| collection | DOAJ |
| description | Background. Secondary hemophagocytic syndrome (SHPS) and sepsis, although very similar in their clinical manifestations and laboratory parameters, essentially differ in terms of methods of their treatment. SHPS therapy is aimed at immunosuppression, whereas in sepsis anti-infectious treatment is required. To choose the correct therapy a rapid differential diagnosis is necessary.
Aim. Search and analysis of criteria of differential diagnosis between SHPS and sepsis.
Materials & Methods. The data of 102 patients were analyzed: 55 SHPS patients (median age 60 and range 18–81 years) and 47 sepsis patients (median age 60 and range 18–89 years). SHPS was diagnosed on the basis of HLH-2004 and H-Score criteria. Sepsis was confirmed by documented inflammatory lesions and systemic inflammatory reactions. Microbiologically confirmed sepsis was reported in 10 (21 %) patients. In all sepsis patients multiple organ failure was identified.
Results. The study of SHPS and sepsis groups revealed significant differences (p < 0.05) in the levels of C-reactive protein, procalcitonin, creatinine, albumin, and sodium. It was also found out that splenomegaly rate and the levels of triglycerides, ferritin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) in SHPS were significantly higher than in sepsis, but the levels of glycosylated ferritin (%GF), fibrinogen, leukocytes, neutrophils, and thrombocytes were lower. The following medians (quartiles 1–3) were reported in SHPS and sepsis, respectively: triglycerides (mmol/L) were 3.1 (2.3–3.8) and 1.5 (0.8–2.7), total ferritin (ng/mL) was 7,170 (3,159.2–12,551.0) and 1,274 (559.0–3,041.5), %GF was 26.5 (16.7–37.3) and 54.5 (37.7–71.8), fibrinogen (g/L) was 2.8 (1.4–4.4) and 5.3 (2.8–6.8), ALT (IU/L) was 50 (20–102) and 30 (15.3–55.5), AST (IU/L) was 66 (40.0–105.6) and 36 (24.6–78.0), leukocytes (×109/L) were 3.7 (2.1–5.5) and 8.9 (6.5–14.5), thrombocytes (×109/L) were 56 (25.2–93.5) and 157 (97–308). According to ROC analysis the areas under the curve were as follows: 0.88 for neutrophil level, 0.85 for total ferritin, %GF, leukocytes, and thrombocytes, 0.74 for triglycerides, 0.71 for fibrinogen, 0.65 for sodium, and 0.61 for ALT and AST.
Conclusion. In differential diagnosis between SHPS and sepsis most important are the levels of total ferritin, its glycosylated fraction, and triglycerides; less important are fibrinogen, neutrophils, thrombocytes and spleen size. As diagnosis and differential diagnosis between SHPS and sepsis are based on the sum total of clinical and laboratory markers, none of the specified characteristics can serve as a reliable parameter if taken separately. |
| format | Article |
| id | doaj-art-aa73f11cc5f643f9b85c6fdee81ba847 |
| institution | OA Journals |
| issn | 1997-6933 2500-2139 |
| language | Russian |
| publishDate | 2019-05-01 |
| publisher | Practical Medicine Publishing House |
| record_format | Article |
| series | Клиническая онкогематология |
| spelling | doaj-art-aa73f11cc5f643f9b85c6fdee81ba8472025-08-20T01:59:52ZrusPractical Medicine Publishing HouseКлиническая онкогематология1997-69332500-21392019-05-0112332933710.21320/2500-2139-2019-12-3-329-33719976933Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and SepsisVG Potapenko0MYu Pervakova1AV Titov2OV Goloshchapov3SV Lapin4EA Surkova5AV Klimovich6OP Mironova7NN Petrova8NYu Chernookaya9EV Karyagina10NV Skorobogatova11ES Pavlyuchenko12EA Karev13NA Potikhonova14VA Dubkova15AYu Kaskov16AV Rysev17TG Kulibaba18NV Medvedeva19 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110 IP Pavlov First Saint Petersburg State Medical University, 6/8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110 IP Pavlov First Saint Petersburg State Medical University, 6/8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022 IP Pavlov First Saint Petersburg State Medical University, 6/8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022 IP Pavlov First Saint Petersburg State Medical University, 6/8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110 Municipal Hospital No. 15, 4 Avangardnaya str., Saint Petersburg, Russian Federation, 198205 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110 II Mechnikov North-Western State Medical University, 41 Kirochnaya str., Saint Petersburg, Russian Federation, 191015 II Mechnikov North-Western State Medical University, 41 Kirochnaya str., Saint Petersburg, Russian Federation, 191015 Russian Research Institute of Hematology and Transfusiology, 16 2-ya Sovetskaya str., Saint Petersburg, Russian Federation, 191024 Saint Petersburg State University, 7/9 Universitetskaya nab., Saint Petersburg, Russian Federation, 199034 II Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine, 3 Budapeshtskaya str., Saint Petersburg, Russian Federation, 192242 II Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine, 3 Budapeshtskaya str., Saint Petersburg, Russian Federation, 192242 Saint Petersburg State University, 7/9 Universitetskaya nab., Saint Petersburg, Russian Federation, 199034 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110 Background. Secondary hemophagocytic syndrome (SHPS) and sepsis, although very similar in their clinical manifestations and laboratory parameters, essentially differ in terms of methods of their treatment. SHPS therapy is aimed at immunosuppression, whereas in sepsis anti-infectious treatment is required. To choose the correct therapy a rapid differential diagnosis is necessary. Aim. Search and analysis of criteria of differential diagnosis between SHPS and sepsis. Materials & Methods. The data of 102 patients were analyzed: 55 SHPS patients (median age 60 and range 18–81 years) and 47 sepsis patients (median age 60 and range 18–89 years). SHPS was diagnosed on the basis of HLH-2004 and H-Score criteria. Sepsis was confirmed by documented inflammatory lesions and systemic inflammatory reactions. Microbiologically confirmed sepsis was reported in 10 (21 %) patients. In all sepsis patients multiple organ failure was identified. Results. The study of SHPS and sepsis groups revealed significant differences (p < 0.05) in the levels of C-reactive protein, procalcitonin, creatinine, albumin, and sodium. It was also found out that splenomegaly rate and the levels of triglycerides, ferritin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) in SHPS were significantly higher than in sepsis, but the levels of glycosylated ferritin (%GF), fibrinogen, leukocytes, neutrophils, and thrombocytes were lower. The following medians (quartiles 1–3) were reported in SHPS and sepsis, respectively: triglycerides (mmol/L) were 3.1 (2.3–3.8) and 1.5 (0.8–2.7), total ferritin (ng/mL) was 7,170 (3,159.2–12,551.0) and 1,274 (559.0–3,041.5), %GF was 26.5 (16.7–37.3) and 54.5 (37.7–71.8), fibrinogen (g/L) was 2.8 (1.4–4.4) and 5.3 (2.8–6.8), ALT (IU/L) was 50 (20–102) and 30 (15.3–55.5), AST (IU/L) was 66 (40.0–105.6) and 36 (24.6–78.0), leukocytes (×109/L) were 3.7 (2.1–5.5) and 8.9 (6.5–14.5), thrombocytes (×109/L) were 56 (25.2–93.5) and 157 (97–308). According to ROC analysis the areas under the curve were as follows: 0.88 for neutrophil level, 0.85 for total ferritin, %GF, leukocytes, and thrombocytes, 0.74 for triglycerides, 0.71 for fibrinogen, 0.65 for sodium, and 0.61 for ALT and AST. Conclusion. In differential diagnosis between SHPS and sepsis most important are the levels of total ferritin, its glycosylated fraction, and triglycerides; less important are fibrinogen, neutrophils, thrombocytes and spleen size. As diagnosis and differential diagnosis between SHPS and sepsis are based on the sum total of clinical and laboratory markers, none of the specified characteristics can serve as a reliable parameter if taken separately. http://bloodjournal.ru/wp-content/uploads/2019/06/12.pdf secondary hemophagocytic syndromesepsisferritinglycosylated ferritintriglycerideshyperferritinemia |
| spellingShingle | VG Potapenko MYu Pervakova AV Titov OV Goloshchapov SV Lapin EA Surkova AV Klimovich OP Mironova NN Petrova NYu Chernookaya EV Karyagina NV Skorobogatova ES Pavlyuchenko EA Karev NA Potikhonova VA Dubkova AYu Kaskov AV Rysev TG Kulibaba NV Medvedeva Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis Клиническая онкогематология secondary hemophagocytic syndrome sepsis ferritin glycosylated ferritin triglycerides hyperferritinemia |
| title | Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis |
| title_full | Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis |
| title_fullStr | Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis |
| title_full_unstemmed | Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis |
| title_short | Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis |
| title_sort | clinical and laboratory characteristics and differential diagnosis between secondary hemophagocytic syndrome and sepsis |
| topic | secondary hemophagocytic syndrome sepsis ferritin glycosylated ferritin triglycerides hyperferritinemia |
| url |
http://bloodjournal.ru/wp-content/uploads/2019/06/12.pdf
|
| work_keys_str_mv | AT vgpotapenko clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT myupervakova clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT avtitov clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT ovgoloshchapov clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT svlapin clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT easurkova clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT avklimovich clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT opmironova clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT nnpetrova clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT nyuchernookaya clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT evkaryagina clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT nvskorobogatova clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT espavlyuchenko clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT eakarev clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT napotikhonova clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT vadubkova clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT ayukaskov clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT avrysev clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT tgkulibaba clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis AT nvmedvedeva clinicalandlaboratorycharacteristicsanddifferentialdiagnosisbetweensecondaryhemophagocyticsyndromeandsepsis |