Markers of prognosis in patients with acute heart failure with preserved ejection fraction developing in the course of hemophagocytosis

INTRODUCTION: Hemophagocytic syndrome is a clinical condition that is a prototype of severe systemic inflammation. Because the clinical presentation includes non-specific and non-typical findings, patients are often lost due to late diagnosis and treatment. Development of preserved ejection fractional heart failure in multiple system findings of this syndrome, myocardial depression secondary to excessive inflammatory cytokine release, directly affects patient mortality and morbidity in the acute phase. AIMS&METHODS: The aim of this study was to evaluate the effects of in-hospital mortality indicators and cheap, easy-to-use and safe laboratory data used in routine follow-up in intensive care patients with these two lethal components together. Between January 2013 and September 2018, from a retrospective file screening of 3090 patients in the intensive care unit of Ege University Hospital, as a result of evaluations of the 63 patients who were diagnosed with hemophagocytic syndrome, accompanying HFpEF was found in 39 patients. The analyzes were performed on 39 patients. RESULTS: Of the 39 patients, 36% (14 patients) were male and 64% (25 patients) were female. The etiology of HS was identified as infection in 10 patients, rheumatic diseases in 20 patients and malignancy in 3 patients. In 6 patients, cause couldn't be identified. 25.6% of the patients (10 patients) died at follow-up. In the univariate analysis; changes in CTR, NT-proBNP, ferritin, CRP and albumin levels over time were identified as predictors of mortality. The results were statistically significant (p = <0.001, 0.007, 0.020, 0.001 and 0.026, respectively). Changes in NLR and MPV were also statistically significant. CONCLUSION: This is the first study evolving the interaction of HFpEF and systemic severe hyperinflammation which includes novel risk factors predicting the patients' course. We think that our non-traditional follow-up parameters are valuable in the case of HFpEF, which is generally difficult to manage and because of high mortality rate. We think that these parameters, which can be easily obtained, cheap and can be followed easily per patient, may be an early warning to physicians during routine patient follow-up. Keywords: Hemophagocytic syndrome, Hearth failure, HFpEF, mortality