Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort studyResearch in context
Summary: Background: Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome characterized by an excessive inflammatory response. Limited data exist on adult HLH. Methods: In this national, retrospective cohort study, we analysed data from the US National Inpatient Sample...
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Elsevier
2023-08-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537023003206 |
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| author | Ali Abdelhay Amir A. Mahmoud Omar Al Ali Anas Hashem Abdullah Orakzai Saad Jamshed |
| author_facet | Ali Abdelhay Amir A. Mahmoud Omar Al Ali Anas Hashem Abdullah Orakzai Saad Jamshed |
| author_sort | Ali Abdelhay |
| collection | DOAJ |
| description | Summary: Background: Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome characterized by an excessive inflammatory response. Limited data exist on adult HLH. Methods: In this national, retrospective cohort study, we analysed data from the US National Inpatient Sample database collected between October 1, 2006 and December 31, 2019. Using the International Classification of Diseases (ICD) codes, we identified all adult patients who were admitted non-electively with the diagnosis of HLH. We described demographic characteristics, triggers, and associated conditions. Trends of diagnosis, treatment, and in-hospital mortality were analysed using joinpoint models. In-hospital mortality rates were compared using multivariable logistic regression models that adjusted for demographic characteristics and associated conditions. Finally, we described resource utilization outcomes including cost of hospitalization and length of stay. Findings: We identified 16,136 non-elective adult HLH admissions. The population pyramid showed a bimodal distribution, with peaks in young adults (16–30 years) and older adults (56–70 years). Joinpoint regression analysis revealed a significant increase in HLH incidence per 100,000 admissions over the study period (Average Annual Percent Change [APC] = 25.3%, p < 0.0001), and no significant change in rates of in-hospital mortality (slope = −0.01; p = 0.95) or administration of in-hospital HLH treatment (slope = 0.46, p = 0.20). The most common associated conditions were malignancy (4953 admissions [30.7%]), infections (3913 admissions [24.3%]), autoimmune conditions (3362 admissions [20.8%]), organ transplant status (639 admissions [4%]), and congenital immunodeficiency syndromes (399 admissions [2.5%]). In-hospital mortality was higher in older adults and males. Furthermore, Congenital immunodeficiency syndromes had the worst in-hospital mortality rate (mortality rate 31.1%, adjusted OR 2.36 [1.56–3.59]), followed by malignancies (mortality rate 28.4%, adjusted OR 1.80 [1.46–2.22]), infections (mortality rate 21.4%, adjusted OR 1.33 [1.10–1.62]), other/no trigger (mortality rate 13.6%, adjusted OR 0.73 [0.58–0.92]), autoimmune (mortality rate 13%, adjusted OR 0.72 [0.57–0.92]), and post-organ transplant status (mortality rate 14.1%, adjusted OR 0.64 [0.43–0.97]). The overall mean length of stay was 14.3 ± 13.9 days, and the mean cost of hospitalization was $54,900 ± 59,800. Interpretation: We provide insight into the burden of adult HLH in the USA. The incidence has been increasing and the outcomes remain dismal. This signifies the growing need for the development of updated diagnosis and treatment protocols that are specific to adult HLH. Funding: None. |
| first_indexed | 2024-03-12T13:50:53Z |
| format | Article |
| id | doaj.art-4912260bd2a84c4190cab827080b4410 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-03-12T13:50:53Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
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| spelling | doaj.art-4912260bd2a84c4190cab827080b44102023-08-23T04:34:07ZengElsevierEClinicalMedicine2589-53702023-08-0162102143Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort studyResearch in contextAli Abdelhay0Amir A. Mahmoud1Omar Al Ali2Anas Hashem3Abdullah Orakzai4Saad Jamshed5Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA; Corresponding author. 1425 Portland Avenue, Rochester, NY 14621, USA.Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USADepartment of Internal Medicine, Rochester General Hospital, Rochester, NY, USADepartment of Internal Medicine, Rochester General Hospital, Rochester, NY, USADepartment of Internal Medicine, Rochester General Hospital, Rochester, NY, USADivision of Hematology and Oncology, Rochester Regional Health, Rochester, NY, USASummary: Background: Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome characterized by an excessive inflammatory response. Limited data exist on adult HLH. Methods: In this national, retrospective cohort study, we analysed data from the US National Inpatient Sample database collected between October 1, 2006 and December 31, 2019. Using the International Classification of Diseases (ICD) codes, we identified all adult patients who were admitted non-electively with the diagnosis of HLH. We described demographic characteristics, triggers, and associated conditions. Trends of diagnosis, treatment, and in-hospital mortality were analysed using joinpoint models. In-hospital mortality rates were compared using multivariable logistic regression models that adjusted for demographic characteristics and associated conditions. Finally, we described resource utilization outcomes including cost of hospitalization and length of stay. Findings: We identified 16,136 non-elective adult HLH admissions. The population pyramid showed a bimodal distribution, with peaks in young adults (16–30 years) and older adults (56–70 years). Joinpoint regression analysis revealed a significant increase in HLH incidence per 100,000 admissions over the study period (Average Annual Percent Change [APC] = 25.3%, p < 0.0001), and no significant change in rates of in-hospital mortality (slope = −0.01; p = 0.95) or administration of in-hospital HLH treatment (slope = 0.46, p = 0.20). The most common associated conditions were malignancy (4953 admissions [30.7%]), infections (3913 admissions [24.3%]), autoimmune conditions (3362 admissions [20.8%]), organ transplant status (639 admissions [4%]), and congenital immunodeficiency syndromes (399 admissions [2.5%]). In-hospital mortality was higher in older adults and males. Furthermore, Congenital immunodeficiency syndromes had the worst in-hospital mortality rate (mortality rate 31.1%, adjusted OR 2.36 [1.56–3.59]), followed by malignancies (mortality rate 28.4%, adjusted OR 1.80 [1.46–2.22]), infections (mortality rate 21.4%, adjusted OR 1.33 [1.10–1.62]), other/no trigger (mortality rate 13.6%, adjusted OR 0.73 [0.58–0.92]), autoimmune (mortality rate 13%, adjusted OR 0.72 [0.57–0.92]), and post-organ transplant status (mortality rate 14.1%, adjusted OR 0.64 [0.43–0.97]). The overall mean length of stay was 14.3 ± 13.9 days, and the mean cost of hospitalization was $54,900 ± 59,800. Interpretation: We provide insight into the burden of adult HLH in the USA. The incidence has been increasing and the outcomes remain dismal. This signifies the growing need for the development of updated diagnosis and treatment protocols that are specific to adult HLH. Funding: None.http://www.sciencedirect.com/science/article/pii/S2589537023003206Haemophagocytic lymphohistiocytosisNational Inpatient SampleCancer epidemiology |
| spellingShingle | Ali Abdelhay Amir A. Mahmoud Omar Al Ali Anas Hashem Abdullah Orakzai Saad Jamshed Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort studyResearch in context EClinicalMedicine Haemophagocytic lymphohistiocytosis National Inpatient Sample Cancer epidemiology |
| title | Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort studyResearch in context |
| title_full | Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort studyResearch in context |
| title_fullStr | Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort studyResearch in context |
| title_full_unstemmed | Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort studyResearch in context |
| title_short | Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort studyResearch in context |
| title_sort | epidemiology characteristics and outcomes of adult haemophagocytic lymphohistiocytosis in the usa 2006 19 a national retrospective cohort studyresearch in context |
| topic | Haemophagocytic lymphohistiocytosis National Inpatient Sample Cancer epidemiology |
| url | http://www.sciencedirect.com/science/article/pii/S2589537023003206 |
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