CD163 as a valuable diagnostic and prognostic biomarker of sepsis‐associated hemophagocytic lymphohistiocytosis in critically ill children

摘要

Abstract Objective To investigate CD163 as an effective biomarker for identifying and predicting the outcomes of sepsis‐associated hemophagocytic lymphohistiocytosis (SAHS) in children. Methods We prospectively enrolled presumed sepsis patients who had developed prolonged fever?(7 days), hepatosplenomegaly, cytopenias, and hyperferritinemia?(500?ng/mL) despite antibiotic therapy. Blood samples were collected within 24?hours after enrolment. A nested case–control study was performed. The number of patients who fulfilled the HLH‐2004 criteria, 28‐day mortality outcomes, and 90‐day mortality outcomes were recorded. Results Sixty‐nine patients were enrolled in the study. Significant increases in the levels of ferritin and soluble CD163 (sCD163) and the percentage of CD163‐positive peripheral blood mononuclear cells (mCD163) and decreases in fibrinogen levels and the percentage of natural killer cells (NK %) were observed in patients with SAHS ( n ?=?23) compared with those of patients with sepsis ( n ?=?46). The area under the ROC curve (AUC) for ferritin combined with sCD163 was superior to the AUC for either ferritin or sCD163 for distinguishing SAHS from sepsis. Moreover, sCD163 was a prognostic factor for 28‐day mortality (0.857 [0.659–1.000]). Conclusions sCD163 is a valuable biomarker for the differential diagnosis of SAHS from sepsis and effectively predicts 28‐day mortality in children with SAHS.