For a study, researchers sought to determine the relationship between the time of a subspecialty consult and the consideration of hemophagocytic lymphohistiocytosis (HLH), the beginning of immunosuppression, and in-hospital mortality in patients with HLH. Between 2006 and 2019, they conducted a medical records review study of individuals 18 years or older with confirmed or suspected HLH at Montefiore Medical Center. Previously, subspecialty consultation (rheumatology, hematology, and infectious disease) was defined as consultation within 18 hours after admission. Patients having early and later specialist consultations were compared in demographics, clinical features, and results.
A total of 28 patients were enrolled in the study. The median age was 40, and 61% of the patients were men. In 13 cases, infection was recognized as the etiology of HLH (46%). About 15 patients (54%) had an earlier subspecialty consultation, with a median (interquartile range) delay to HLH consideration of 1.0 days (0.3–4.2 days) compared to 7.9 days (3.1–9.9 days) for the later consultation group (P=0.002). The median (interquartile range) time to start immunosuppression was 4.6 days (1.7–7.8 days) vs. 10.9 days (5.1–13.4 days) (P=0.01). In-hospital fatalities occurred in 5 patients (33%) in the early consultation group vs. seven patients (54%) in the later consultation group (P=0.27). The 90-day readmission rate was more significant in the later consultation group (83% vs. 30%, P=0.12) among the subset of patients who lived to release. Early subspecialty consultation in patients with HLH might have a role in earlier HLH consideration and therapy commencement.
