A simple clinical tool for effective screening of haemophagocytic lymphohistiocytosis in dengue.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-04-22 DOI:10.1007/s15010-025-02542-8

Jeco Jacob Kuttykandathil, Arfath Ahmed, Gauri Malavalli Girish, Chyavan Trisule Reddy Tummaluru, Vivek Kothandaraman Koushik, Tapendu Patoary, Chakrapani Mahabala

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Abstract

Purpose: Haemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disorder. Dengue fever is a common trigger for HLH in the tropics. We aimed to develop a simplified clinical tool to detect HLH in dengue patients.

Methods: A cross-sectional observational study was carried out at Kasturba Medical College Mangalore. Patients between 18 and 60 years of age, with dengue fever for more than five days with suspected HLH symptoms were selected. Hepatosplenomegaly, temperature, haemoglobin levels, total leucocyte count, platelet count, ferritin, triglyceride, and liver function tests were assessed. HLH-2004 criteria were used to confirm the diagnosis. A simple clinical tool was developed via decision tree analysis using clinical and laboratory parameters.

Results: Patients with HLH had marked leucopenia, thrombocytopenia, hyperferritinaemia and elevated aspartate aminotransferase levels, and a greater incidence of hepatosplenomegaly than those without HLH. Decision tree analysis was used to generate a clinical diagnostic tool, which demonstrated an accuracy of 94%, at a confidence interval of 95% (90-98%). The model's ability to predict HLH was 79%, while its specificity was 96%. It had a positive predictive value of 68% and a negative predictive value of 97%. The kappa value of the predicted model was 0.70, indicating an agreement with the diagnosis using HLH-2004 criteria, with a significant p-value (< 0.001).

Conclusions: Splenomegaly can be used as a screening method to diagnose HLH in patients with dengue. By using an algorithmic approach, combining splenomegaly with leucopenia and thrombocytopenia, this clinical tool accurately detects HLH in patients with dengue.

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一个简单的临床工具，有效筛选在登革热嗜血淋巴组织细胞增多症。

目的：噬血细胞性淋巴组织细胞增多症（HLH）是一种罕见的危及生命的疾病。在热带地区，登革热是HLH的常见诱因。我们的目标是开发一种简化的临床工具来检测登革热患者的HLH。方法：在芒格洛尔Kasturba医学院进行横断面观察研究。选择年龄在18至60岁之间、登革热病程超过5天且疑似HLH症状的患者。评估肝脾肿大、体温、血红蛋白水平、总白细胞计数、血小板计数、铁蛋白、甘油三酯和肝功能试验。采用HLH-2004标准确诊。通过使用临床和实验室参数进行决策树分析，开发了一种简单的临床工具。结果：HLH患者有明显的白细胞减少、血小板减少、高铁血症和天冬氨酸转氨酶水平升高，肝脾肿大发生率高于非HLH患者。决策树分析用于生成临床诊断工具，其准确率为94%，置信区间为95%（90-98%）。该模型预测HLH的能力为79%，特异性为96%。阳性预测值为68%，阴性预测值为97%。预测模型kappa值为0.70，与HLH-2004诊断标准一致，p值显著（结论脾肿大可作为诊断登革热患者HLH的筛查方法）。通过使用一种算法方法，结合脾肿大、白细胞减少和血小板减少，这种临床工具可以准确地检测登革热患者的HLH。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.