Prognostic Value of Laboratory Biomarkers in Risk Stratification for Short-Term Outcomes in Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis

Abstract

Objectives

This study aimed to investigate the association between laboratory biomarkers and short-term poor prognosis in patients with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) and to develop a risk stratification model.

Methods

A retrospective analysis was conducted on clinical data from 117 EBV-HLH patients admitted to our hospital between June 2016 and December 2024. Patients were classified into poor prognosis (n=48) and good prognosis (n=69) groups based on 28-day outcomes. Potential predictors were screened by univariable logistic regression and receiver operating characteristic (ROC) curve analysis, and a composite laboratory-based risk scoring system was subsequently constructed.

Results

The poor prognosis group exhibited significantly higher levels of urea (UREA), direct bilirubin (DB), high-sensitivity cardiac troponin I (hscTnI), serum ferritin (Ferr), and prothrombin time (PT) than the good prognosis group did (all P<0.05). ROC analysis determined the optimal cutoff values and corresponding odds ratios (ORs) for poor prognosis as follows: UREA (≥5.4 mmol/L, OR=5.911), DB (≥10.0 μmol/L, OR=2.524), hscTnI (≥7.4 pg/mL, OR=2.747), Ferr (≥12,422 μg/L, OR=2.366), and PT (≥14.1 s, OR=3.221). A 0–5-point risk score model was constructed based on these thresholds. The incidence of poor prognosis increased progressively with the score: 23.08% (score 0–1), 27.59% (score 2), 45.00% (score 3), 66.67% (score 4), and 92.30% (score 5). Each 1-point increase in the score was associated with an OR of 1.915 for poor prognosis.

Conclusion

The composite risk scoring system incorporating UREA, DB, hscTnI, Ferr, and PT showed satisfactory predictive performance for short-term outcomes in EBV-HLH patients. A score of≥3 identifies high-risk individuals who may benefit from intensified immunomodulatory therapy, thereby facilitating individualized and stratified clinical management.

Keywords

EBV-HLH / Prognostic biomarkers / Hemophagocytic lymphohistiocytosis / Risk stratification / Ferritin / Troponin I / Urea / Coagulophathy

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The Author(s), under exclusive licence to the Huazhong University of Science and Technology