Intensive care requirement, rather than degree of serum ferritin elevation, predicts mortality in macrophage activation syndrome

摘要

We appreciate the comments by Drs. Mannion and Cron (1) regarding our article (2) and also the opportunity to reply provided to us by the editors. In their letter, Drs. Mannion and Cron report data regarding 46 patients at their own institution with ferritin levels >3000 ng/mL, including descriptive information about immunosuppressive therapies received by the patients, and briefly review the literature on anakinra use for macrophage activation syndrome (MAS). Drs. Mannion and Cron note that among their 46 patients, no mortality was seen in those not admitted to the intensive care unit (ICU), and that the ranges of ferritin levels observed in their patients admitted to the ICU and not admitted to the ICU were similar. On the basis of this observation, they suggest that "[i]nstead of using an elevated serum ferritin level as a marker for mortality, it should be considered a marker of uncontrolled systemic inflammation, which indicates the need for early addition of immunomodu-latory therapy" (1).