{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T09:24:10Z","timestamp":1789032250692,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T00:00:00Z","timestamp":1613520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of pathologic immune activation. Most studies on adult HLH have evaluated prognostic factors for overall survival; factors predicting early mortality have not been sufficiently investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a collaborative study between Henry Ford Hospital and Barnes\u2010Jewish Hospital. We identified all adult HLH patients with at least 2 ferritin levels within 30\u00a0days from admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One\u2010hundred twenty\u2010four patients were identified. There were 77 males and 47 females; the median age at diagnosis was 48\u00a0years. Multivariate analysis showed that age (OR\u00a0=\u00a011.41; 95% CI:2.71\u201048.04;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.001), hepatomegaly (OR\u00a0=\u00a015.68; 95% CI:3.24\u201075.96;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.001), hyponatremia (OR\u00a0=\u00a05.94; 95% CI:1.76\u201020.1;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.004), hypoalbuminemia (OR\u00a0=\u00a07.47; 95% CI:2.08\u201026.85;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.002), and increasing ferritin levels (OR\u00a0=\u00a019.46; 95% CI:4.69\u201080.71;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) were significant predictors of 30\u2010day mortality. Patients with declining ferritin by more than 35% from the ferritin peak were more likely to survive the first 30\u00a0days of admission (OR\u00a0=\u00a04.33; 95% CI:1.04\u201018.1;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.033). By risk stratifying our cohort, we identified changes in ferritin levels to be the most significant prognostic factor of 30\u2010day mortality among other risk factors. Further investigating the prognostic utility of ferritin showed that increasing ferritin during the 1st week of admission (data available for 44 patients) was the only significant predictor of 30\u2010day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>To the best of our knowledge, this is the first study reporting changes in ferritin to be a predictor for early death in adult HLH. Changes in ferritin might be a useful indicator of adult HLH disease activity and early prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijlh.13489","type":"journal-article","created":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T21:56:35Z","timestamp":1613598995000},"page":"1024-1031","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Increasing ferritin predicts early death in adult hemophagocytic lymphohistiocytosis"],"prefix":"10.1111","volume":"43","author":[{"given":"Rand","family":"Abou Shaar","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Henry Ford Hospital Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles S.","family":"Eby","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology Washington University School of Medicine St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"van Dorp","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center Nijmegen Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"de Witte","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center Nijmegen Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5823-2694","authenticated-orcid":false,"given":"Zaher K.","family":"Otrock","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Henry Ford Hospital Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOP.0b013e32834ec9c1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2147\/JBM.S46255"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.06.053"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqaa124"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-med-041610-134208"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2011.10.015"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21564"},{"key":"e_1_2_8_9_1","first-page":"29","article-title":"Diagnostic guidelines for hemophagocytic lymphohistiocytosis. 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