{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:37:24Z","timestamp":1793039844430,"version":"4.5.0"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To study the clinical features and outcomes of macrophage activation syndrome in lupus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective study conducted in a tertiary care referral centre from 2017 to 2022. Consecutive hospitalised adult-onset SLE patients diagnosed with MAS, fulfilling the Parodi criteria with ferritin &gt;500\u00a0ng\/ml were included. All the other hospitalised SLE patients without MAS served as controls. Clinical and immunological features and in-hospital mortality was compared between the 2 groups. Risk factors for mortality in MAS patients were determined performing univariate and multivariate analyses with a stepwise logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 623 hospitalisations in 451 SLE patients, 86 met the case definition for MAS and 526 served as controls. MAS occurred at the time of SLE diagnosis in 54 (62.9%). MAS was associated with fever, hepatosplenomegaly, lymphadenopathy, cytopenia, and elevated transaminases. Disease activity (clinical SLEDAI 2K) was significantly higher in MAS (mean 13.7 \u00b1 6.5 vs. 8 \u00b1 5.9 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). In-hospital mortality was higher in the MAS compared to the control group [13 (15%) vs 6 (1%),\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001]. Mortality in MAS was associated with higher ferritin (12092.9 \u00b1 2826.5 vs 3993.6 \u00b1 735, &lt;0.001) and aspartate aminotransferase (544 \u00b1 239 vs 167.66 \u00b1 27.28U\/L,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), seizures (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.035), altered mental status (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.004), shock (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), intensive care unit admission (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), and mechanical ventilation (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). On multivariate regression analysis -ferritin &gt;2400{OR-8.1 95% CI: (1.46-44.85)\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      - 0.017} and seizures {OR-7.3 95% CI: (1.2-44.29)\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      - 0.030} were associated with mortality in MAS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MAS is a rare complication of active lupus identified by fever, elevated ferritin, liver transaminases and cytopenia and is associated with high in hospital mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033261500970","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T15:39:33Z","timestamp":1792769973000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Macrophage activation syndrome is associated with high in-hospital mortality in patients with lupus"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8433-9882","authenticated-orcid":false,"given":"Benzeeta","family":"Pinto","sequence":"first","affiliation":[{"name":"St John\u2019s Medical College Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kodali","family":"Ramya Sri","sequence":"additional","affiliation":[{"name":"St John\u2019s Medical College Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Narayan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, St John's Medical College Hospital, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramya","family":"Janardana","sequence":"additional","affiliation":[{"name":"St John\u2019s Medical College Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Salih","family":"Salim","sequence":"additional","affiliation":[{"name":"St John\u2019s Medical College Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna C.","family":"Das","sequence":"additional","affiliation":[{"name":"St John\u2019s Medical College Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5271-0766","authenticated-orcid":false,"given":"Vineeta","family":"Shobha","sequence":"additional","affiliation":[{"name":"St John\u2019s Medical College 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Pancreatitis in systemic juvenile idiopathic arthritis. 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