{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:12:44Z","timestamp":1788667964794,"version":"build-2803163510"},"reference-count":47,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Clinical Translational Medicine Research Project of Anhui Province","award":["202427b10020064"],"award-info":[{"award-number":["202427b10020064"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82370225"],"award-info":[{"award-number":["82370225"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medicine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome with cytokine storm-mediated multiorgan damage. Although serous effusions are frequent complications, the prognostic significance of peritoneal effusion in secondary HLH (sHLH) remains undefined. This study aimed to determine the incidence, clinical and immunological correlates, and prognostic value of peritoneal effusion in sHLH patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 107 adult patients diagnosed with sHLH at the Second Affiliated Hospital of Anhui Medical University between March 2013 and March 2023. Peritoneal effusion was diagnosed based on abdominal ultrasound, computed tomography, or positron emission tomography\u2013computed tomography at initial presentation. Clinical characteristics, laboratory parameters, and lymphocyte subset profiles were compared between patients with and without peritoneal effusion. Logistic regression was used to identify risk factors for peritoneal effusion. Overall survival (OS) was estimated using the Kaplan\u2013Meier method, and independent prognostic factors were assessed using multivariate Cox regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Peritoneal effusion was found in 24\/107 (22.4%) sHLH patients and was associated with lower white blood cell, lymphocyte, monocyte, and platelet counts. Lower monocyte counts, higher direct bilirubin, and distinct immune dysregulation (reduced CD4+ T cells, higher NK cell percentages) were identified as risk factors for peritoneal effusion. Peritoneal effusion correlated with concurrent serous effusions (p &lt; 0.05) and markedly shorter median survival (19 vs. 103 days, p = 0.002). Multivariate analysis identified peritoneal effusion as an independent mortality predictor (HR=1.88; 95% CI 1.09-3.24, p = 0.023).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Peritoneal effusion is an independent predictor of mortality in sHLH patients and is associated with a distinct immune profile. Its presence should alert clinicians to a higher risk of death and prompt early, aggressive therapeutic intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20503121261487052","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T22:57:35Z","timestamp":1788476255000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Peritoneal effusion as a marker of disease severity in secondary hemophagocytic lymphohistiocytosis: Clinical and immunological insights"],"prefix":"10.1177","volume":"14","author":[{"given":"Yansheng","family":"Wang","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4110-9466","authenticated-orcid":false,"given":"Lulu","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiping","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Li","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furun","family":"An","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beibei","family":"Xie","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangwei","family":"Ying","sequence":"additional","affiliation":[{"name":"Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinxiao","family":"Hou","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Qin","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhimin","family":"Zhai","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Wu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Anhui Medical University"},{"name":"The Second Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-pathol-020117-043625"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2020.101515"},{"key":"e_1_3_8_4_2","first-page":"197","article-title":"Hemophagocytic lymphohistiocytosis. Report of 122 children from the International Registry","volume":"10","author":"Aric\u00f2 M","year":"1996","unstructured":"Aric\u00f2 M, Janka G, Fischer A, et al. Hemophagocytic lymphohistiocytosis. Report of 122 children from the International Registry. FHL Study Group of the Histiocyte Society. Leukemia 1996; 10: 197\u2013203.","journal-title":"FHL Study Group of the Histiocyte Society. Leukemia"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.614704"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-025-09068-9"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.19.21788"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.11.004"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-022-03333-9"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2024025077"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.11.029"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz499"},{"key":"e_1_3_8_13_2","first-page":"420","article-title":"Macrophage activation syndrome as a severe manifestation of adult's Still's disease. Hemophagocytic cells in ascites","volume":"10","author":"Eg\u00fces Dubuc C","year":"2014","unstructured":"Eg\u00fces Dubuc C, Uriarte Ecenarro M, Errazquin Aguirre N, et al. Macrophage activation syndrome as a severe manifestation of adult's Still's disease. Hemophagocytic cells in ascites. Reumatol Clin 2014; 10: 420\u2013421. https:\/\/doi.org\/10.1016\/j.reuma.2014.04.004","journal-title":"Reumatol Clin"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/dc.24999"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v26.i2.199"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.7150\/thno.42385"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clcc.2016.04.014"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/cas.13723"},{"key":"e_1_3_8_19_2","first-page":"371","article-title":"An unusual cause of ascites: hemophagocytic lymphohistiocytosis","volume":"44","author":"Akcam M","year":"2007","unstructured":"Akcam M, Artan R, Yilmaz A, et al. An unusual cause of ascites: hemophagocytic lymphohistiocytosis. Indian Pediatr 2007; 44: 371\u2013374.","journal-title":"Indian Pediatr"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v7.i19.3069"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2303030223"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2020.11.023"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20102538"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0226043"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.786190"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-43909-w"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-023-02768-8"},{"key":"e_1_3_8_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-021-01109-0"},{"key":"e_1_3_8_29_2","doi-asserted-by":"publisher","DOI":"10.1080\/21505594.2024.2342276"},{"key":"e_1_3_8_30_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021013549"},{"key":"e_1_3_8_31_2","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v11.i5.989"},{"key":"e_1_3_8_32_2","first-page":"521","article-title":"Management of superior vena cava syndrome in critically ill cancer patients","volume":"26","author":"Morin S","year":"2018","unstructured":"Morin S, Grateau A, Reuter D, et al. Management of superior vena cava syndrome in critically ill cancer patients. Support Care Cancer 2018; 26: 521\u2013528. https:\/\/doi.org\/10.1007\/s00520-017-3860-z","journal-title":"Support Care Cancer"},{"key":"e_1_3_8_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-018-0621-6"},{"key":"e_1_3_8_34_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcibr1007320"},{"key":"e_1_3_8_35_2","doi-asserted-by":"publisher","DOI":"10.3390\/cells11121935"},{"key":"e_1_3_8_36_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201910-1911TR"},{"key":"e_1_3_8_37_2","doi-asserted-by":"publisher","DOI":"10.1111\/cei.13450"},{"key":"e_1_3_8_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1016-8478(23)17590-X"},{"key":"e_1_3_8_39_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-019-11878-3"},{"key":"e_1_3_8_40_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019003664"},{"key":"e_1_3_8_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.imbio.2023.152759"},{"key":"e_1_3_8_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-003-0894-9"},{"key":"e_1_3_8_43_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1668762"},{"key":"e_1_3_8_44_2","doi-asserted-by":"publisher","DOI":"10.1155\/2001\/651470"},{"key":"e_1_3_8_45_2","doi-asserted-by":"publisher","DOI":"10.1159\/000325558"},{"key":"e_1_3_8_46_2","first-page":"e41182","article-title":"Hemophagocytic lymphohistiocytosis associated with polyserositis and Salmonella typhi infection","volume":"15","author":"Achakzai H","year":"2023","unstructured":"Achakzai H, Ghutai G, Khalil D, et al. Hemophagocytic lymphohistiocytosis associated with polyserositis and Salmonella typhi infection. Cureus 2023; 15: e41182. https:\/\/doi.org\/10.7759\/cureus.41182","journal-title":"Cureus"},{"key":"e_1_3_8_47_2","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.935915"},{"key":"e_1_3_8_48_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61060977"}],"container-title":["Sage Open Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20503121261487052","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20503121261487052","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20503121261487052","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T03:51:07Z","timestamp":1788666667000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20503121261487052"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":47,"alternative-id":["10.1177\/20503121261487052"],"URL":"https:\/\/doi.org\/10.1177\/20503121261487052","relation":{},"ISSN":["2050-3121","2050-3121"],"issn-type":[{"value":"2050-3121","type":"print"},{"value":"2050-3121","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"article-number":"20503121261487052"}}