1. Understanding Disseminated Intravascular Coagulation and Hepatobiliary Dysfunction Multiple Organ Failure in Hyperferritinemic Critical Illness*
- Author
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Dennis W. Simon, Kate F. Kernan, Bita Shakoory, and Joseph A. Carcillo
- Subjects
0301 basic medicine ,Disseminated intravascular coagulation ,medicine.medical_specialty ,Extramural ,business.industry ,Critical Illness ,Multiple Organ Failure ,MEDLINE ,030208 emergency & critical care medicine ,Disseminated Intravascular Coagulation ,Critical Care and Intensive Care Medicine ,medicine.disease ,Lymphohistiocytosis, Hemophagocytic ,Article ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,hemic and lymphatic diseases ,Pediatrics, Perinatology and Child Health ,Critical illness ,medicine ,Humans ,Child ,Intensive care medicine ,business - Abstract
OBJECTIVE: Hemophagocytic lymphohistiocytosis (HLH) poses significant challenges due to limited tools to guide clinical decisions in a population at high risk of death. We sought to assess whether disseminated intravascular coagulation (DIC) and hepatobiliary dysfunction (HBD), significant comorbidities seen in critical care settings, would identify HLH patients with increased risk of mortality. DESIGN: Retrospective chart review. SETTING: Single-center pediatric intensive care unit PATIENTS: All patients admitted to a tertiary care children’s hospital diagnosed with HLH from 2005 – 2012 INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Forty-three patients were diagnosed with HLH with median age of 61 months. The 5-year overall survival was 51% (22/43). Univariate analyses revealed ferritin levels > 10,000 (ng/mL), international normalized ratio >1.5, or platelet counts < 100,000/mcL at initiation of dexamethasone were individually associated with mortality. Development of DIC, HBD or both increased the likelihood of death in HLH patients (relative risk; 95% confidence interval) (6; 1.4 – 34; p
- Published
- 2018
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