Comorbidities Drive Outcomes for Both Malignancy-Associated and Non-Malignancy-Associated Hemophagocytic Syndrome

Benny Johnson, Smith Giri, Sara E. Nunnery, Eric Wiedower, Omer Jamy, George Yaghmour, Jason C. Chandler, Michael Martin

Research output: Contribution to journalArticle

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Abstract

Background Secondary hemophagocytic syndrome (SHPS) is a syndrome that develops as a result of infection, autoimmunity, or underlying malignancy. We studied novel predictors of mortality among adults with SHPS. Patients and Methods SHPS were identified from the Nationwide Inpatient Sample for 2009 to 2011 using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes. Charlson comorbidity index (CCI) was used for comorbidity assessment, excluding malignancy. Patient- and hospital-related factors on mortality were assessed by chi-square test or analysis of variance. P values were 2 sided, and the level of significance was.05. Results A total of 276 patient hospitalizations with SHPS were identified. Forty-four had an associated malignancy, 38 (86%) of which were hematologic. Median age was 42 years (range, 18-89 years). A total of 66% (n = 182) had a CCI of 0, 13% (n = 27) had a CCI of 1, and 21% (n = 57) had a CCI of 2 or more. On bivariate analysis, inpatient mortality rate was significantly higher in malignancy-associated hemophagocytic syndrome (HPS) (odds ratio [OR], 2.07; P =.04), age ≥ 50 years (OR, 3.46; P <.01), CCI ≥ 2 (OR, 3.04; P <.01), and Medicare patients (OR, 2.32; P <.01). In multivariate analysis, CCI ≥ 2 remained an independent predictor of survival in the overall study cohort (OR, 3.52; 95% confidence interval, 1.51-8.18; P <.01). Conclusion Malignancy-associated HPS, CCI ≥ 2, age > 50 years, and Medicare patients were associated with a worse in-hospital mortality. In multivariate analysis, greater comorbidity burden appeared to be the single most important predictor of mortality. This suggests that outcomes for adults with HPS are predicated by the extent of organ dysfunction at diagnosis.

Original languageEnglish (US)
Pages (from-to)230-236
Number of pages7
JournalClinical Lymphoma, Myeloma and Leukemia
Volume16
Issue number4
DOIs
StatePublished - Apr 1 2016

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Hemophagocytic Lymphohistiocytosis
Comorbidity
Neoplasms
Mortality
Inpatients
Odds Ratio
International Classification of Diseases
Chi-Square Distribution
Medicare
Hospital Mortality
Autoimmunity
Analysis of Variance
Hospitalization
Multivariate Analysis
Infection

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Cancer Research

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Comorbidities Drive Outcomes for Both Malignancy-Associated and Non-Malignancy-Associated Hemophagocytic Syndrome. / Johnson, Benny; Giri, Smith; Nunnery, Sara E.; Wiedower, Eric; Jamy, Omer; Yaghmour, George; Chandler, Jason C.; Martin, Michael.

In: Clinical Lymphoma, Myeloma and Leukemia, Vol. 16, No. 4, 01.04.2016, p. 230-236.

Research output: Contribution to journalArticle

Johnson, Benny ; Giri, Smith ; Nunnery, Sara E. ; Wiedower, Eric ; Jamy, Omer ; Yaghmour, George ; Chandler, Jason C. ; Martin, Michael. / Comorbidities Drive Outcomes for Both Malignancy-Associated and Non-Malignancy-Associated Hemophagocytic Syndrome. In: Clinical Lymphoma, Myeloma and Leukemia. 2016 ; Vol. 16, No. 4. pp. 230-236.
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abstract = "Background Secondary hemophagocytic syndrome (SHPS) is a syndrome that develops as a result of infection, autoimmunity, or underlying malignancy. We studied novel predictors of mortality among adults with SHPS. Patients and Methods SHPS were identified from the Nationwide Inpatient Sample for 2009 to 2011 using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes. Charlson comorbidity index (CCI) was used for comorbidity assessment, excluding malignancy. Patient- and hospital-related factors on mortality were assessed by chi-square test or analysis of variance. P values were 2 sided, and the level of significance was.05. Results A total of 276 patient hospitalizations with SHPS were identified. Forty-four had an associated malignancy, 38 (86{\%}) of which were hematologic. Median age was 42 years (range, 18-89 years). A total of 66{\%} (n = 182) had a CCI of 0, 13{\%} (n = 27) had a CCI of 1, and 21{\%} (n = 57) had a CCI of 2 or more. On bivariate analysis, inpatient mortality rate was significantly higher in malignancy-associated hemophagocytic syndrome (HPS) (odds ratio [OR], 2.07; P =.04), age ≥ 50 years (OR, 3.46; P <.01), CCI ≥ 2 (OR, 3.04; P <.01), and Medicare patients (OR, 2.32; P <.01). In multivariate analysis, CCI ≥ 2 remained an independent predictor of survival in the overall study cohort (OR, 3.52; 95{\%} confidence interval, 1.51-8.18; P <.01). Conclusion Malignancy-associated HPS, CCI ≥ 2, age > 50 years, and Medicare patients were associated with a worse in-hospital mortality. In multivariate analysis, greater comorbidity burden appeared to be the single most important predictor of mortality. This suggests that outcomes for adults with HPS are predicated by the extent of organ dysfunction at diagnosis.",
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T1 - Comorbidities Drive Outcomes for Both Malignancy-Associated and Non-Malignancy-Associated Hemophagocytic Syndrome

AU - Johnson, Benny

AU - Giri, Smith

AU - Nunnery, Sara E.

AU - Wiedower, Eric

AU - Jamy, Omer

AU - Yaghmour, George

AU - Chandler, Jason C.

AU - Martin, Michael

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background Secondary hemophagocytic syndrome (SHPS) is a syndrome that develops as a result of infection, autoimmunity, or underlying malignancy. We studied novel predictors of mortality among adults with SHPS. Patients and Methods SHPS were identified from the Nationwide Inpatient Sample for 2009 to 2011 using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes. Charlson comorbidity index (CCI) was used for comorbidity assessment, excluding malignancy. Patient- and hospital-related factors on mortality were assessed by chi-square test or analysis of variance. P values were 2 sided, and the level of significance was.05. Results A total of 276 patient hospitalizations with SHPS were identified. Forty-four had an associated malignancy, 38 (86%) of which were hematologic. Median age was 42 years (range, 18-89 years). A total of 66% (n = 182) had a CCI of 0, 13% (n = 27) had a CCI of 1, and 21% (n = 57) had a CCI of 2 or more. On bivariate analysis, inpatient mortality rate was significantly higher in malignancy-associated hemophagocytic syndrome (HPS) (odds ratio [OR], 2.07; P =.04), age ≥ 50 years (OR, 3.46; P <.01), CCI ≥ 2 (OR, 3.04; P <.01), and Medicare patients (OR, 2.32; P <.01). In multivariate analysis, CCI ≥ 2 remained an independent predictor of survival in the overall study cohort (OR, 3.52; 95% confidence interval, 1.51-8.18; P <.01). Conclusion Malignancy-associated HPS, CCI ≥ 2, age > 50 years, and Medicare patients were associated with a worse in-hospital mortality. In multivariate analysis, greater comorbidity burden appeared to be the single most important predictor of mortality. This suggests that outcomes for adults with HPS are predicated by the extent of organ dysfunction at diagnosis.

AB - Background Secondary hemophagocytic syndrome (SHPS) is a syndrome that develops as a result of infection, autoimmunity, or underlying malignancy. We studied novel predictors of mortality among adults with SHPS. Patients and Methods SHPS were identified from the Nationwide Inpatient Sample for 2009 to 2011 using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes. Charlson comorbidity index (CCI) was used for comorbidity assessment, excluding malignancy. Patient- and hospital-related factors on mortality were assessed by chi-square test or analysis of variance. P values were 2 sided, and the level of significance was.05. Results A total of 276 patient hospitalizations with SHPS were identified. Forty-four had an associated malignancy, 38 (86%) of which were hematologic. Median age was 42 years (range, 18-89 years). A total of 66% (n = 182) had a CCI of 0, 13% (n = 27) had a CCI of 1, and 21% (n = 57) had a CCI of 2 or more. On bivariate analysis, inpatient mortality rate was significantly higher in malignancy-associated hemophagocytic syndrome (HPS) (odds ratio [OR], 2.07; P =.04), age ≥ 50 years (OR, 3.46; P <.01), CCI ≥ 2 (OR, 3.04; P <.01), and Medicare patients (OR, 2.32; P <.01). In multivariate analysis, CCI ≥ 2 remained an independent predictor of survival in the overall study cohort (OR, 3.52; 95% confidence interval, 1.51-8.18; P <.01). Conclusion Malignancy-associated HPS, CCI ≥ 2, age > 50 years, and Medicare patients were associated with a worse in-hospital mortality. In multivariate analysis, greater comorbidity burden appeared to be the single most important predictor of mortality. This suggests that outcomes for adults with HPS are predicated by the extent of organ dysfunction at diagnosis.

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