Clinical characteristics and prognostic analysis of pediatric hemophagocytic lymphohistiocytosis using lasso-logistic regression.

Abstract

This study aims to evaluate and predict mortality risks among pediatric patients with hemophagocytic lymphohistiocytosis (HLH). We conducted a retrospective analysis of pediatric patients with HLH diagnosed at the Affiliated Hospital of Zunyi Medical University between January 2012 and April 2023. Patients were divided into a death group and a survival group based on their outcomes. Risk factors for mortality were analyzed using a lasso-logistic regression model. This study included 142 pediatric patients with HLH, with a median age of 40.5 (14.75-84) months, of whom 78 (54.93%) were male. The overall mortality rate was 34.51%. Through lasso-logistic regression analysis, five independent prognostic factors were identified: concurrent central nervous system involvement, multiple organ dysfunction syndrome involving three or more organs, platelet count ≤ 42.5 × 10⁹/L, activated partial thromboplastin time ≥ 54.05 s, and the utilization of blood purification in conjunction with the HLH-94/2004 treatment protocol. The predictive value of the lasso-logistic regression model is better than that of the traditional logistic regression model (AUC: 0.906 vs 0.811, P = 0.001). Subsequently, a lasso-logistic regression-based predictive model incorporating these identified risk factors was developed. Our lasso-logistic regression-based prediction model may help to identify high-risk patients with HLH early, thereby enabling the timely initiation of appropriate treatment interventions.