When should hemodialysis or plasma exchange be used to reduce early death in hemophagocytic lymphohistiocytosis?

Background: Successful management of early death is a key for patients with hemophagocytic lymphohistiocytosis (HLH) to have a better prognosis, and hemodialysis (HD) and plasma exchange (PE) are effective to control hypercytokinemia. This study was to answer when HD or PE should be used to reduce the early death in adult patients with HLH. Methods: The clinical data of 21 patients with HLH and their laboratory values at admission were retrospectively analyzed. Results: Of the 21 patients 3 survived, 18 died. 5 patients had no obvious underlying disease, but the other 16 had, including Epstein-Barr virus (EBV) or bacterial infections, autoimmune disease, or lymphoma. After 4 patients were ruled out of statistical analysis due to abandoning follow-up treatment or not being an adult, Fisher's Exact Test and Cox Regression revealed that serum ferritin (SF) ≥ 10000 ng/ml and serum lactate dehydrogenase (LDH) ≥ 1000 IU/L were obviously correlated with early death of adult patients (p < 0.05). Conclusion: After considering all issues relevant we might say that when SF ≥ 10000 ng/ml and/or LDH ≥ 1000 IU/L, HD or PE should be timely used to reduce early death.