Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica

Introducción: La linfohistiocitosis hemofagocítica (HLH) es un síndrome hiperinflamatorio infrecuente y potencialmente mortal, caracterizado por activación inmunitaria descontrolada y daño multiorgánico. Su diagnóstico es complejo por su presentación heterogénea y similitud con otras enfermedades gr...

Full description

Autores:: Sanchez Bautista, Julian David
Aristizabal Garcia, Camilo
Mora Atehortua, Maria Isabel
Atencia Flórez, Carlos José
Gaviria Jaramillo, Lina María
Ospina Ospina, Sigifredo

Tipo de recurso:: Article of investigation

Fecha de publicación:: 2025

Institución:: Universidad de Antioquia

Repositorio:: Repositorio UdeA

Idioma:: spa

id	UDEA2_db54313a4251af5a5d6fd3d3ec89ad2f
oai_identifier_str	oai:bibliotecadigital.udea.edu.co:10495/46781
network_acronym_str	UDEA2
network_name_str	Repositorio UdeA
repository_id_str
dc.title.spa.fl_str_mv	Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica
title	Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica
spellingShingle	Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica Linfohistiocitosis hemofagocítica Lymphohistiocytosis, Hemophagocytic Cuidados críticos Critical Care Enfermedad Catastrófica Catastrophic Illness https://id.nlm.nih.gov/mesh/D051359 https://id.nlm.nih.gov/mesh/D003422 https://id.nlm.nih.gov/mesh/D002388 ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades
title_short	Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica
title_full	Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica
title_fullStr	Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica
title_full_unstemmed	Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica
title_sort	Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica
dc.creator.fl_str_mv	Sanchez Bautista, Julian David Aristizabal Garcia, Camilo Mora Atehortua, Maria Isabel Atencia Flórez, Carlos José Gaviria Jaramillo, Lina María Ospina Ospina, Sigifredo
dc.contributor.advisor.none.fl_str_mv	Gaviria Jaramillo, Lina Maria
dc.contributor.author.none.fl_str_mv	Sanchez Bautista, Julian David Aristizabal Garcia, Camilo Mora Atehortua, Maria Isabel Atencia Flórez, Carlos José Gaviria Jaramillo, Lina María Ospina Ospina, Sigifredo
dc.contributor.jury.none.fl_str_mv	Herrera, Guillermo Villada, Juan Camilo
dc.subject.decs.none.fl_str_mv	Linfohistiocitosis hemofagocítica Lymphohistiocytosis, Hemophagocytic Cuidados críticos Critical Care Enfermedad Catastrófica Catastrophic Illness
topic	Linfohistiocitosis hemofagocítica Lymphohistiocytosis, Hemophagocytic Cuidados críticos Critical Care Enfermedad Catastrófica Catastrophic Illness https://id.nlm.nih.gov/mesh/D051359 https://id.nlm.nih.gov/mesh/D003422 https://id.nlm.nih.gov/mesh/D002388 ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades
dc.subject.meshuri.none.fl_str_mv	https://id.nlm.nih.gov/mesh/D051359 https://id.nlm.nih.gov/mesh/D003422 https://id.nlm.nih.gov/mesh/D002388
dc.subject.ods.none.fl_str_mv	ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades
description	Introducción: La linfohistiocitosis hemofagocítica (HLH) es un síndrome hiperinflamatorio infrecuente y potencialmente mortal, caracterizado por activación inmunitaria descontrolada y daño multiorgánico. Su diagnóstico es complejo por su presentación heterogénea y similitud con otras enfermedades graves; existe poca información en Latinoamérica. Este estudio busca describir las características clínicas, etiológicas y desenlaces de pacientes con HLH en un hospital de alta complejidad en Medellín y evalúa el H Score al diagnóstico como herramienta pronóstica. Métodos: Estudio de corte transversal retrospectivo entre 2012 y 2024 en el Hospital Universitario San Vicente Fundación. Se incluyeron pacientes con HLH según criterios HLH-2004 o H Score. Se analizaron variables clínicas, de laboratorio y tratamiento. El desenlace principal fue mortalidad intrahospitalaria atribuible a HLH. Se realizó análisis univariado y multivariado buscando factores asociados a mortalidad y se evaluó la capacidad pronóstica del H Score con curvas ROC. Resultados: Se incluyeron 94 pacientes (mediana 15 años; 53,1% hombres). El 21,2% presentó HLH primaria; las causas secundarias principales fueron autoinmunidad (35,1%) e infección (32,9%). La mortalidad global fue 34%. Variables asociadas de forma independiente a mortalidad: leucocitos <2000/mL (OR 4,62; IC 1,01-21,0), H Score >246 (OR 6; IC 1,43-25,5) e ingreso a UCI (OR 89; IC 14,2-555). El H Score mostró buen rendimiento pronóstico (AUC 93,9%; sensibilidad 67,2%; especificidad 71%). Conclusión La HLH continúa siendo de alta letalidad. Mayor riesgo de muerte ante citopenias graves, manejo en UCI y H Score elevado. Este estudio respalda el H Score como herramienta diagnóstica y pronóstica. Se requieren estudios multicéntricos para confirmar estos hallazgos.
publishDate	2025
dc.date.accessioned.none.fl_str_mv	2025-07-17T00:50:34Z
dc.date.issued.none.fl_str_mv	2025
dc.type.none.fl_str_mv	Trabajo de grado - Especialización
dc.type.coar.none.fl_str_mv	http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.redcol.none.fl_str_mv	http://purl.org/redcol/resource_type/ART
dc.type.content.none.fl_str_mv	Text
dc.type.coarversion.none.fl_str_mv	http://purl.org/coar/version/c_b1a7d7d4d402bcce
dc.type.driver.none.fl_str_mv	info:eu-repo/semantics/article
dc.type.version.none.fl_str_mv	info:eu-repo/semantics/draft
format	http://purl.org/coar/resource_type/c_2df8fbb1
status_str	draft
dc.identifier.uri.none.fl_str_mv	https://hdl.handle.net/10495/46781
url	https://hdl.handle.net/10495/46781
dc.language.iso.none.fl_str_mv	spa
language	spa
dc.relation.references.none.fl_str_mv	[1] J.-I. Henter, “Hemophagocytic Lymphohistiocytosis,” N Engl J Med, vol. 392, no. 6, pp. 584–598, Feb. 2025, doi: 10.1056/NEJMRA2314005. [2] S. J. Carter, R. S. Tattersall, and A. V. Ramanan, “Macrophage activation syndrome in adults: recent advances in pathophysiology, diagnosis and treatment,” Rheumatology (Oxford), vol. 58, no. 1, pp. 5–17, Jan. 2019, doi: 10.1093/RHEUMATOLOGY/KEY006. [3] S. Badugu, M. Elder, and T. Smith, “Macrophage activation syndrome, an important differential diagnosis for septic shock,” J Pediatr Intensive Care, vol. 1, no. 4, p. 211, 2012, doi: 10.3233/PIC-12035. [4] T. S. Ponnatt, C. M. Lilley, and K. M. Mirza, “Hemophagocytic Lymphohistiocytosis,” Arch Pathol Lab Med, vol. 146, no. 4, pp. 507–519, Apr. 2022, doi: 10.5858/ARPA.2020-0802-RA. [5] N. S. Bhatt, B. Oshrine, and J. An Talano, “Hemophagocytic lymphohistiocytosis in adults,” Leuk Lymphoma, vol. 60, no. 1, pp. 19–28, Jan. 2019, doi: 10.1080/10428194.2018.1482543. [6] P. La Rosée et al., “Recommendations for the management of hemophagocytic lymphohistiocytosis in adults,” Blood, vol. 133, no. 23, pp. 2465–2477, Jun. 2019, doi: 10.1182/BLOOD.2018894618. [7] A. M. Schram and N. Berliner, “How I treat hemophagocytic lymphohistiocytosis in the adult patient,” Blood, vol. 125, no. 19, pp. 2908–2914, May 2015, doi: 10.1182/BLOOD-2015-01-551622. [8] L. Fardet et al., “Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome,” Arthritis Rheumatol, vol. 66, no. 9, pp. 2613–2620, 2014, doi: 10.1002/ART.38690. [9] E. Bergsten et al., “Confirmed efficacy of etoposide and dexamethasone in HLH treatment: long-term results of the cooperative HLH-2004 study,” Blood, vol. 130, no. 25, pp. 2728–2738, Dec. 2017, doi: 10.1182/BLOOD-2017-06-788349. [10] M. Ramos-Casals, P. Brito-Zerón, A. López-Guillermo, M. A. Khamashta, and X. Bosch, “Adult haemophagocytic syndrome,” Lancet, vol. 383, no. 9927, pp. 1503–1516, 2014, doi: 10.1016/S0140-6736(13)61048-X. [11] A. J. M. Ferreri et al., “Variations in clinical presentation, frequency of hemophagocytosis and clinical behavior of intravascular lymphoma diagnosed in different geographical regions,” Haematologica, vol. 92, no. 4, pp. 486–492, Apr. 2007, doi: 10.3324/HAEMATOL.10829. [12] J. F. Nieto-Ríos, A. Aristizabal-Alzate, C. Ocampo, A. K. Serrano-Gayubo, L. M. Serna-Higuita, and G. Zuluaga-Valencia, “Histoplasmosis diseminada y síndrome hemofagocítico en dos pacientes trasplantados renales,” Nefrología, vol. 32, no. 5, pp. 683–684, Sep. 2012, doi: 10.3265/NEFROLOGIA.PRE2012.JUN.11508. [13] J. F. Nieto, S. M. Gómez, D. C. Moncada, L. M. Serna, and A. I. Hidrón, “Tratamiento exitoso de linfohistiocitosis hemofagocítica y coagulación intravascular diseminada secundarias a histoplasmosis en un paciente con HIV/sida,” Biomédica, vol. 36, pp. 9–14, Apr. 2016, doi: 10.7705/BIOMEDICA.V36I2.2797. [14] C. A. P. Romero et al., “A novel pathogenic variant in PRF1 associated with hemophagocytic lymphohistiocytosis,” J Clin Immunol, vol. 35, no. 5, pp. 501–511, Jul. 2015, doi: 10.1007/S10875-015-0169-X. [15] J. Uribe-Londono, L. M. Castano-Jaramillo, L. Penagos-Tascon, A. Restrepo-Gouzy, and A.-F. Escobar-Gonzalez, “Hemophagocytic Lymphohistiocytosis Associated with Salmonella typhi Infection in a Child: A Case Report with Review of Literature,” Case Rep Pediatr, vol. 2018, pp. 1–4, Nov. 2018, doi: 10.1155/2018/6236270. [16] T. Barba et al., “Hemophagocytic Lymphohistiocytosis in Intensive Care Unit: A 71-Case Strobe-Compliant Retrospective Study,” Medicine, vol. 94, no. 51, 2015, doi: 10.1097/MD.0000000000002318. [17] M. Zhou et al., “Clinical features and outcomes in secondary adult hemophagocytic lymphohistiocytosis,” QJM, vol. 111, no. 1, pp. 23–31, Jan. 2018, doi: 10.1093/QJMED/HCX183. [18] P. Hernández-Jiménez, C. Díaz-Pedroche, J. Laureiro, O. Madrid, E. Martín, and C. Lumbreras, “[Hemophagocytic lymphohistiocytosis: Analysis of 18 cases],” Med Clin (Barc), vol. 147, no. 11, pp. 495–498, Dec. 2016, doi: 10.1016/J.MEDCLI.2016.07.031. [19] J. K. Signoff, J. C. Fitzgerald, D. T. Teachey, F. Balamuth, and S. L. Weiss, “Hypofibrinogenemia Is Associated With Poor Outcome and Secondary Hemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome in Pediatric Severe Sepsis,” Pediatr Crit Care Med, vol. 19, no. 5, pp. 397–405, May 2018, doi: 10.1097/PCC.0000000000001507. [20] Y. Guo, Y. Bai, and L. Gu, “Clinical features and prognostic factors of adult secondary hemophagocytic syndrome: Analysis of 47 cases,” Medicine, vol. 96, no. 22, Jun. 2017, doi: 10.1097/MD.0000000000006935. [21] S. Valade et al., “Coagulation Disorders and Bleedings in Critically Ill Patients With Hemophagocytic Lymphohistiocytosis,” Medicine, vol. 94, no. 40, Oct. 2015, doi: 10.1097/MD.0000000000001692. [22] M. Xie et al., “An effective diagnostic index for lymphoma-associated hemophagocytic syndrome,” QJM, vol. 111, no. 8, pp. 541–547, Aug. 2018, doi: 10.1093/QJMED/HCY103. [23] S. Grangé et al., “The Use of Ferritin to Identify Critically Ill Patients With Secondary Hemophagocytic Lymphohistiocytosis,” Crit Care Med, vol. 44, no. 11, pp. e1045–e1053, Nov. 2016, doi: 10.1097/CCM.0000000000001878. [24] A. Kwak et al., “A retrospective analysis of etiology and outcomes of hemophagocytic lymphohistiocytosis in children and adults,” Yeungnam Univ J Med, vol. 38, no. 3, pp. 208–218, Jul. 2021, doi: 10.12701/YUJM.2020.00591. [25] M. H. N. Nguyen, M. Baker, T. Spoden, M. G. Rivera-Valenzuela, and R. Azmeh, “Hemophagocytic lymphohistiocytosis in adult and pediatric patients: Perspectives from a tertiary care center,” Annals of Allergy, Asthma and Immunology, vol. 127, no. 4, pp. 507–509, Oct. 2021, doi: 10.1016/j.anai.2021.07.009. [26] X. Wang et al., “Disparity Analysis of Clinical Features and Prognostic Evaluation of Hemophagocytic Lymphohistiocytosis in Pediatric and Adult Patients: A Retrospective Multicenter Study of 525 Cases in HHLWG,” Acta Haematol, vol. 146, no. 3, pp. 185–195, Jun. 2023, doi: 10.1159/000528934. [27] A. Ravelli et al., “2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative,” Arthritis Rheumatol, vol. 68, no. 3, pp. [28] J. I. Henter et al., “HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis,” Pediatr Blood Cancer, vol. 48, no. 2, pp. 124–131, Feb. 2007, doi: 10.1002/PBC.21039. [29] C. Knaak et al., “Hemophagocytic lymphohistiocytosis in critically ill patients: diagnostic reliability of HLH-2004 criteria and HScore,” Crit Care, vol. 24, no. 1, May 2020, doi: 10.1186/S13054-020-02941-3.
dc.rights.uri.none.fl_str_mv	http://creativecommons.org/licenses/by-nc-sa/4.0/
dc.rights.accessrights.none.fl_str_mv	info:eu-repo/semantics/openAccess
dc.rights.license.en.fl_str_mv	Attribution-NonCommercial-ShareAlike 4.0 International
dc.rights.coar.none.fl_str_mv	http://purl.org/coar/access_right/c_abf2
rights_invalid_str_mv	http://creativecommons.org/licenses/by-nc-sa/4.0/ Attribution-NonCommercial-ShareAlike 4.0 International http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv	openAccess
dc.format.extent.none.fl_str_mv	25 páginas
dc.format.mimetype.none.fl_str_mv	application/pdf
dc.publisher.none.fl_str_mv	Universidad de Antioquia
dc.publisher.program.none.fl_str_mv	Especialización en Hematología Clínica
dc.publisher.department.none.fl_str_mv	Departamento de Medicina Interna
dc.publisher.place.none.fl_str_mv	Medellín, Colombia
dc.publisher.faculty.none.fl_str_mv	Facultad de Medicina
dc.publisher.branch.none.fl_str_mv	Campus en el Área de la salud
publisher.none.fl_str_mv	Universidad de Antioquia
institution	Universidad de Antioquia
bitstream.url.fl_str_mv	https://bibliotecadigital.udea.edu.co/bitstreams/cafb1416-33d1-4000-9553-4cbaa1b17fb7/download https://bibliotecadigital.udea.edu.co/bitstreams/0233e520-3c62-40d4-a0c6-4b87f7c7d10c/download https://bibliotecadigital.udea.edu.co/bitstreams/411c1abe-9459-4ed7-9d07-b63568aeb11b/download https://bibliotecadigital.udea.edu.co/bitstreams/7ca89272-3970-4a0b-bc4a-0f053cafb9a3/download https://bibliotecadigital.udea.edu.co/bitstreams/223a5790-c156-4b88-a203-a59c2ec83ced/download https://bibliotecadigital.udea.edu.co/bitstreams/01bff25d-feef-4517-81e4-2ee090c0aa8f/download https://bibliotecadigital.udea.edu.co/bitstreams/0189ffc0-85f0-4b1d-8f6e-60255b8cfce6/download https://bibliotecadigital.udea.edu.co/bitstreams/d939991a-b263-487b-b35a-d2d0698881f5/download https://bibliotecadigital.udea.edu.co/bitstreams/1410412e-abd7-4faa-b768-d348a5060352/download https://bibliotecadigital.udea.edu.co/bitstreams/cefb7c51-da91-48c8-9066-baac3449d6e8/download https://bibliotecadigital.udea.edu.co/bitstreams/f3f79fe1-356b-4f83-b46c-1c2d61e90d36/download https://bibliotecadigital.udea.edu.co/bitstreams/108221da-0829-4af7-84a6-da5ec34987f5/download https://bibliotecadigital.udea.edu.co/bitstreams/7f140a0b-10d7-4670-a9ab-86cdebdfd194/download https://bibliotecadigital.udea.edu.co/bitstreams/963d7047-60df-4774-9df8-7218ad86472c/download https://bibliotecadigital.udea.edu.co/bitstreams/5efee6b7-5184-49a3-a161-f7423a2cdcfb/download https://bibliotecadigital.udea.edu.co/bitstreams/648dca17-13af-4432-9f55-4a9ae7c4e4af/download https://bibliotecadigital.udea.edu.co/bitstreams/93643f70-852a-4e9e-a672-8cec9f4cce00/download https://bibliotecadigital.udea.edu.co/bitstreams/03a8b53f-f8e6-43ef-9f37-510a0963c8aa/download https://bibliotecadigital.udea.edu.co/bitstreams/16eaa917-3896-4daa-b04d-5e78ae40aa93/download https://bibliotecadigital.udea.edu.co/bitstreams/f9b41afe-7d62-4a85-9319-56293d99b2a2/download
bitstream.checksum.fl_str_mv	334b50b15db872b3667496e7e9524424 888b9b2198521a641db794cad4a9695a 12efcdb2169ebd375d927b81927a7a45 668e3ccf22b6bb082d0d3ed77df8ac89 c9f767854573abe5fdd4836c32911d7e b48d4ad13a27d719b7d3e3927bf40496 b76e7a76e24cf2f94b3ce0ae5ed275d0 5643bfd9bcf29d560eeec56d584edaa9 4c6869d680bc7351945d695815c24a2e ba4c585d4d23437d7334ba46af8b8c45 4c12d5c00efb1e00a4ae1411cefc3506 9f925cb7800e9e10f702b0e5cd69cc21 1b2dee876f0f8997983c350ace15bd23 6de5cb8ea7a29286387b14385c0d4560 ec02c7431e2571bff3cf316d56781afb d6ed61695954e7365fa14cd6a4de8a86 ebcdb0e5b762cc474ff4c98898990be2 f8ac44022a75efaefa8aa8148e5cbaf1 6fbb29ba60a96d3846b6591b205d59b4 0e17401edba1ba4541dfc51c455e1112
bitstream.checksumAlgorithm.fl_str_mv	MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5 MD5
repository.name.fl_str_mv	Repositorio Institucional de la Universidad de Antioquia
repository.mail.fl_str_mv	aplicacionbibliotecadigitalbiblioteca@udea.edu.co
_version_	1851052594619744256
spelling	Gaviria Jaramillo, Lina MariaSanchez Bautista, Julian DavidAristizabal Garcia, CamiloMora Atehortua, Maria IsabelAtencia Flórez, Carlos JoséGaviria Jaramillo, Lina MaríaOspina Ospina, SigifredoHerrera, GuillermoVillada, Juan Camilo2025-07-17T00:50:34Z2025https://hdl.handle.net/10495/46781Introducción: La linfohistiocitosis hemofagocítica (HLH) es un síndrome hiperinflamatorio infrecuente y potencialmente mortal, caracterizado por activación inmunitaria descontrolada y daño multiorgánico. Su diagnóstico es complejo por su presentación heterogénea y similitud con otras enfermedades graves; existe poca información en Latinoamérica. Este estudio busca describir las características clínicas, etiológicas y desenlaces de pacientes con HLH en un hospital de alta complejidad en Medellín y evalúa el H Score al diagnóstico como herramienta pronóstica. Métodos: Estudio de corte transversal retrospectivo entre 2012 y 2024 en el Hospital Universitario San Vicente Fundación. Se incluyeron pacientes con HLH según criterios HLH-2004 o H Score. Se analizaron variables clínicas, de laboratorio y tratamiento. El desenlace principal fue mortalidad intrahospitalaria atribuible a HLH. Se realizó análisis univariado y multivariado buscando factores asociados a mortalidad y se evaluó la capacidad pronóstica del H Score con curvas ROC. Resultados: Se incluyeron 94 pacientes (mediana 15 años; 53,1% hombres). El 21,2% presentó HLH primaria; las causas secundarias principales fueron autoinmunidad (35,1%) e infección (32,9%). La mortalidad global fue 34%. Variables asociadas de forma independiente a mortalidad: leucocitos <2000/mL (OR 4,62; IC 1,01-21,0), H Score >246 (OR 6; IC 1,43-25,5) e ingreso a UCI (OR 89; IC 14,2-555). El H Score mostró buen rendimiento pronóstico (AUC 93,9%; sensibilidad 67,2%; especificidad 71%). Conclusión La HLH continúa siendo de alta letalidad. Mayor riesgo de muerte ante citopenias graves, manejo en UCI y H Score elevado. Este estudio respalda el H Score como herramienta diagnóstica y pronóstica. Se requieren estudios multicéntricos para confirmar estos hallazgos.EspecializaciónEspecialista en Hematología Clínica25 páginasapplication/pdfspaUniversidad de AntioquiaEspecialización en Hematología ClínicaDepartamento de Medicina InternaMedellín, ColombiaFacultad de MedicinaCampus en el Área de la saludhttp://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccessAttribution-NonCommercial-ShareAlike 4.0 Internationalhttp://purl.org/coar/access_right/c_abf2Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocíticaTrabajo de grado - Especializaciónhttp://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/redcol/resource_type/ARTTexthttp://purl.org/coar/version/c_b1a7d7d4d402bcceinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/draft[1] J.-I. Henter, “Hemophagocytic Lymphohistiocytosis,” N Engl J Med, vol. 392, no. 6, pp. 584–598, Feb. 2025, doi: 10.1056/NEJMRA2314005.[2] S. J. Carter, R. S. Tattersall, and A. V. Ramanan, “Macrophage activation syndrome in adults: recent advances in pathophysiology, diagnosis and treatment,” Rheumatology (Oxford), vol. 58, no. 1, pp. 5–17, Jan. 2019, doi: 10.1093/RHEUMATOLOGY/KEY006.[3] S. Badugu, M. Elder, and T. Smith, “Macrophage activation syndrome, an important differential diagnosis for septic shock,” J Pediatr Intensive Care, vol. 1, no. 4, p. 211, 2012, doi: 10.3233/PIC-12035.[4] T. S. Ponnatt, C. M. Lilley, and K. M. Mirza, “Hemophagocytic Lymphohistiocytosis,” Arch Pathol Lab Med, vol. 146, no. 4, pp. 507–519, Apr. 2022, doi: 10.5858/ARPA.2020-0802-RA.[5] N. S. Bhatt, B. Oshrine, and J. An Talano, “Hemophagocytic lymphohistiocytosis in adults,” Leuk Lymphoma, vol. 60, no. 1, pp. 19–28, Jan. 2019, doi: 10.1080/10428194.2018.1482543.[6] P. La Rosée et al., “Recommendations for the management of hemophagocytic lymphohistiocytosis in adults,” Blood, vol. 133, no. 23, pp. 2465–2477, Jun. 2019, doi: 10.1182/BLOOD.2018894618.[7] A. M. Schram and N. Berliner, “How I treat hemophagocytic lymphohistiocytosis in the adult patient,” Blood, vol. 125, no. 19, pp. 2908–2914, May 2015, doi: 10.1182/BLOOD-2015-01-551622.[8] L. Fardet et al., “Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome,” Arthritis Rheumatol, vol. 66, no. 9, pp. 2613–2620, 2014, doi: 10.1002/ART.38690.[9] E. Bergsten et al., “Confirmed efficacy of etoposide and dexamethasone in HLH treatment: long-term results of the cooperative HLH-2004 study,” Blood, vol. 130, no. 25, pp. 2728–2738, Dec. 2017, doi: 10.1182/BLOOD-2017-06-788349.[10] M. Ramos-Casals, P. Brito-Zerón, A. López-Guillermo, M. A. Khamashta, and X. Bosch, “Adult haemophagocytic syndrome,” Lancet, vol. 383, no. 9927, pp. 1503–1516, 2014, doi: 10.1016/S0140-6736(13)61048-X.[11] A. J. M. Ferreri et al., “Variations in clinical presentation, frequency of hemophagocytosis and clinical behavior of intravascular lymphoma diagnosed in different geographical regions,” Haematologica, vol. 92, no. 4, pp. 486–492, Apr. 2007, doi: 10.3324/HAEMATOL.10829.[12] J. F. Nieto-Ríos, A. Aristizabal-Alzate, C. Ocampo, A. K. Serrano-Gayubo, L. M. Serna-Higuita, and G. Zuluaga-Valencia, “Histoplasmosis diseminada y síndrome hemofagocítico en dos pacientes trasplantados renales,” Nefrología, vol. 32, no. 5, pp. 683–684, Sep. 2012, doi: 10.3265/NEFROLOGIA.PRE2012.JUN.11508.[13] J. F. Nieto, S. M. Gómez, D. C. Moncada, L. M. Serna, and A. I. Hidrón, “Tratamiento exitoso de linfohistiocitosis hemofagocítica y coagulación intravascular diseminada secundarias a histoplasmosis en un paciente con HIV/sida,” Biomédica, vol. 36, pp. 9–14, Apr. 2016, doi: 10.7705/BIOMEDICA.V36I2.2797.[14] C. A. P. Romero et al., “A novel pathogenic variant in PRF1 associated with hemophagocytic lymphohistiocytosis,” J Clin Immunol, vol. 35, no. 5, pp. 501–511, Jul. 2015, doi: 10.1007/S10875-015-0169-X.[15] J. Uribe-Londono, L. M. Castano-Jaramillo, L. Penagos-Tascon, A. Restrepo-Gouzy, and A.-F. Escobar-Gonzalez, “Hemophagocytic Lymphohistiocytosis Associated with Salmonella typhi Infection in a Child: A Case Report with Review of Literature,” Case Rep Pediatr, vol. 2018, pp. 1–4, Nov. 2018, doi: 10.1155/2018/6236270.[16] T. Barba et al., “Hemophagocytic Lymphohistiocytosis in Intensive Care Unit: A 71-Case Strobe-Compliant Retrospective Study,” Medicine, vol. 94, no. 51, 2015, doi: 10.1097/MD.0000000000002318.[17] M. Zhou et al., “Clinical features and outcomes in secondary adult hemophagocytic lymphohistiocytosis,” QJM, vol. 111, no. 1, pp. 23–31, Jan. 2018, doi: 10.1093/QJMED/HCX183.[18] P. Hernández-Jiménez, C. Díaz-Pedroche, J. Laureiro, O. Madrid, E. Martín, and C. Lumbreras, “[Hemophagocytic lymphohistiocytosis: Analysis of 18 cases],” Med Clin (Barc), vol. 147, no. 11, pp. 495–498, Dec. 2016, doi: 10.1016/J.MEDCLI.2016.07.031.[19] J. K. Signoff, J. C. Fitzgerald, D. T. Teachey, F. Balamuth, and S. L. Weiss, “Hypofibrinogenemia Is Associated With Poor Outcome and Secondary Hemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome in Pediatric Severe Sepsis,” Pediatr Crit Care Med, vol. 19, no. 5, pp. 397–405, May 2018, doi: 10.1097/PCC.0000000000001507.[20] Y. Guo, Y. Bai, and L. Gu, “Clinical features and prognostic factors of adult secondary hemophagocytic syndrome: Analysis of 47 cases,” Medicine, vol. 96, no. 22, Jun. 2017, doi: 10.1097/MD.0000000000006935.[21] S. Valade et al., “Coagulation Disorders and Bleedings in Critically Ill Patients With Hemophagocytic Lymphohistiocytosis,” Medicine, vol. 94, no. 40, Oct. 2015, doi: 10.1097/MD.0000000000001692.[22] M. Xie et al., “An effective diagnostic index for lymphoma-associated hemophagocytic syndrome,” QJM, vol. 111, no. 8, pp. 541–547, Aug. 2018, doi: 10.1093/QJMED/HCY103.[23] S. Grangé et al., “The Use of Ferritin to Identify Critically Ill Patients With Secondary Hemophagocytic Lymphohistiocytosis,” Crit Care Med, vol. 44, no. 11, pp. e1045–e1053, Nov. 2016, doi: 10.1097/CCM.0000000000001878.[24] A. Kwak et al., “A retrospective analysis of etiology and outcomes of hemophagocytic lymphohistiocytosis in children and adults,” Yeungnam Univ J Med, vol. 38, no. 3, pp. 208–218, Jul. 2021, doi: 10.12701/YUJM.2020.00591.[25] M. H. N. Nguyen, M. Baker, T. Spoden, M. G. Rivera-Valenzuela, and R. Azmeh, “Hemophagocytic lymphohistiocytosis in adult and pediatric patients: Perspectives from a tertiary care center,” Annals of Allergy, Asthma and Immunology, vol. 127, no. 4, pp. 507–509, Oct. 2021, doi: 10.1016/j.anai.2021.07.009.[26] X. Wang et al., “Disparity Analysis of Clinical Features and Prognostic Evaluation of Hemophagocytic Lymphohistiocytosis in Pediatric and Adult Patients: A Retrospective Multicenter Study of 525 Cases in HHLWG,” Acta Haematol, vol. 146, no. 3, pp. 185–195, Jun. 2023, doi: 10.1159/000528934.[27] A. Ravelli et al., “2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative,” Arthritis Rheumatol, vol. 68, no. 3, pp.[28] J. I. Henter et al., “HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis,” Pediatr Blood Cancer, vol. 48, no. 2, pp. 124–131, Feb. 2007, doi: 10.1002/PBC.21039.[29] C. Knaak et al., “Hemophagocytic lymphohistiocytosis in critically ill patients: diagnostic reliability of HLH-2004 criteria and HScore,” Crit Care, vol. 24, no. 1, May 2020, doi: 10.1186/S13054-020-02941-3.Linfohistiocitosis hemofagocíticaLymphohistiocytosis, HemophagocyticCuidados críticosCritical CareEnfermedad CatastróficaCatastrophic Illnesshttps://id.nlm.nih.gov/mesh/D051359https://id.nlm.nih.gov/mesh/D003422https://id.nlm.nih.gov/mesh/D002388ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edadesPublicationORIGINALSanchezJulian_2025_HLHPronosticoMortalidad.pdfSanchezJulian_2025_HLHPronosticoMortalidad.pdfTrabajo de grado de especializaciónapplication/pdf117522https://bibliotecadigital.udea.edu.co/bitstreams/cafb1416-33d1-4000-9553-4cbaa1b17fb7/download334b50b15db872b3667496e7e9524424MD56trueAnonymousREADAnexo 1 Graficas.pdfAnexo 1 Graficas.pdfapplication/pdf102429https://bibliotecadigital.udea.edu.co/bitstreams/0233e520-3c62-40d4-a0c6-4b87f7c7d10c/download888b9b2198521a641db794cad4a9695aMD51falseAnonymousREADAnexo 2 Tabla 1.pdfAnexo 2 Tabla 1.pdfapplication/pdf158723https://bibliotecadigital.udea.edu.co/bitstreams/411c1abe-9459-4ed7-9d07-b63568aeb11b/download12efcdb2169ebd375d927b81927a7a45MD52falseAnonymousREADAnexo 3 Tabla 2.pdfAnexo 3 Tabla 2.pdfapplication/pdf121268https://bibliotecadigital.udea.edu.co/bitstreams/7ca89272-3970-4a0b-bc4a-0f053cafb9a3/download668e3ccf22b6bb082d0d3ed77df8ac89MD53falseAnonymousREADAnexo 4 Tabla 3.pdfAnexo 4 Tabla 3.pdfapplication/pdf114171https://bibliotecadigital.udea.edu.co/bitstreams/223a5790-c156-4b88-a203-a59c2ec83ced/downloadc9f767854573abe5fdd4836c32911d7eMD54falseAnonymousREADAnexo 5 Tabla 4.pdfAnexo 5 Tabla 4.pdfapplication/pdf80226https://bibliotecadigital.udea.edu.co/bitstreams/01bff25d-feef-4517-81e4-2ee090c0aa8f/downloadb48d4ad13a27d719b7d3e3927bf40496MD55falseAnonymousREADLICENSElicense.txtlicense.txttext/plain; charset=utf-814837https://bibliotecadigital.udea.edu.co/bitstreams/0189ffc0-85f0-4b1d-8f6e-60255b8cfce6/downloadb76e7a76e24cf2f94b3ce0ae5ed275d0MD58falseAnonymousREADCC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-81160https://bibliotecadigital.udea.edu.co/bitstreams/d939991a-b263-487b-b35a-d2d0698881f5/download5643bfd9bcf29d560eeec56d584edaa9MD59falseAnonymousREADTEXTSanchezJulian_2025_HLHPronosticoMortalidad.pdf.txtSanchezJulian_2025_HLHPronosticoMortalidad.pdf.txtExtracted texttext/plain35708https://bibliotecadigital.udea.edu.co/bitstreams/1410412e-abd7-4faa-b768-d348a5060352/download4c6869d680bc7351945d695815c24a2eMD510falseAnonymousREADAnexo 1 Graficas.pdf.txtAnexo 1 Graficas.pdf.txtExtracted texttext/plain503https://bibliotecadigital.udea.edu.co/bitstreams/cefb7c51-da91-48c8-9066-baac3449d6e8/downloadba4c585d4d23437d7334ba46af8b8c45MD512falseAnonymousREADAnexo 2 Tabla 1.pdf.txtAnexo 2 Tabla 1.pdf.txtExtracted texttext/plain4807https://bibliotecadigital.udea.edu.co/bitstreams/f3f79fe1-356b-4f83-b46c-1c2d61e90d36/download4c12d5c00efb1e00a4ae1411cefc3506MD514falseAnonymousREADAnexo 3 Tabla 2.pdf.txtAnexo 3 Tabla 2.pdf.txtExtracted texttext/plain1596https://bibliotecadigital.udea.edu.co/bitstreams/108221da-0829-4af7-84a6-da5ec34987f5/download9f925cb7800e9e10f702b0e5cd69cc21MD516falseAnonymousREADAnexo 4 Tabla 3.pdf.txtAnexo 4 Tabla 3.pdf.txtExtracted texttext/plain1512https://bibliotecadigital.udea.edu.co/bitstreams/7f140a0b-10d7-4670-a9ab-86cdebdfd194/download1b2dee876f0f8997983c350ace15bd23MD518falseAnonymousREADAnexo 5 Tabla 4.pdf.txtAnexo 5 Tabla 4.pdf.txtExtracted texttext/plain349https://bibliotecadigital.udea.edu.co/bitstreams/963d7047-60df-4774-9df8-7218ad86472c/download6de5cb8ea7a29286387b14385c0d4560MD520falseAnonymousREADTHUMBNAILSanchezJulian_2025_HLHPronosticoMortalidad.pdf.jpgSanchezJulian_2025_HLHPronosticoMortalidad.pdf.jpgGenerated Thumbnailimage/jpeg8811https://bibliotecadigital.udea.edu.co/bitstreams/5efee6b7-5184-49a3-a161-f7423a2cdcfb/downloadec02c7431e2571bff3cf316d56781afbMD511falseAnonymousREADAnexo 1 Graficas.pdf.jpgAnexo 1 Graficas.pdf.jpgGenerated Thumbnailimage/jpeg5424https://bibliotecadigital.udea.edu.co/bitstreams/648dca17-13af-4432-9f55-4a9ae7c4e4af/downloadd6ed61695954e7365fa14cd6a4de8a86MD513falseAnonymousREADAnexo 2 Tabla 1.pdf.jpgAnexo 2 Tabla 1.pdf.jpgGenerated Thumbnailimage/jpeg11260https://bibliotecadigital.udea.edu.co/bitstreams/93643f70-852a-4e9e-a672-8cec9f4cce00/downloadebcdb0e5b762cc474ff4c98898990be2MD515falseAnonymousREADAnexo 3 Tabla 2.pdf.jpgAnexo 3 Tabla 2.pdf.jpgGenerated Thumbnailimage/jpeg11824https://bibliotecadigital.udea.edu.co/bitstreams/03a8b53f-f8e6-43ef-9f37-510a0963c8aa/downloadf8ac44022a75efaefa8aa8148e5cbaf1MD517falseAnonymousREADAnexo 4 Tabla 3.pdf.jpgAnexo 4 Tabla 3.pdf.jpgGenerated Thumbnailimage/jpeg11924https://bibliotecadigital.udea.edu.co/bitstreams/16eaa917-3896-4daa-b04d-5e78ae40aa93/download6fbb29ba60a96d3846b6591b205d59b4MD519falseAnonymousREADAnexo 5 Tabla 4.pdf.jpgAnexo 5 Tabla 4.pdf.jpgGenerated Thumbnailimage/jpeg5750https://bibliotecadigital.udea.edu.co/bitstreams/f9b41afe-7d62-4a85-9319-56293d99b2a2/download0e17401edba1ba4541dfc51c455e1112MD521falseAnonymousREAD10495/46781oai:bibliotecadigital.udea.edu.co:10495/467812025-07-18 04:09:45.27http://creativecommons.org/licenses/by-nc-sa/4.0/Attribution-NonCommercial-ShareAlike 4.0 Internationalopen.accesshttps://bibliotecadigital.udea.edu.coRepositorio Institucional de la Universidad de Antioquiaaplicacionbibliotecadigitalbiblioteca@udea.edu.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

Valor pronóstico para mortalidad del h-score en pacientes adultos y pediátricos con linfohistiocitosis hemofagocítica

Publicaciones similares