Prognostic Value of Lipid Profile in Pediatric Secondary Hemophagocytic Lymphohistiocytosis Patients

Background: Secondary hemophagocytic lymphohistiocytosis (sHLH) is a severe hyperinflammatory syndrome, with unchecked immune activation and cytokine storm, leading to progressive multiorgan dysfunction. Although therapeutic approaches have improved, morbidity is still very high, especially in children with severe clinical features. The objective is to evaluate the prognostic significance of lipid profile abnormalities in pediatric secondary HLH patients and determine their association with survival outcomes. Material and Methods: This prospective observational study was conducted over a period of 2.5 years in the Department of Pediatrics, Government Medical College, Srinagar. Forty-eight pediatric patients aged 4–18 years diagnosed with secondary HLH according to modified HLH-2004 criteria were enrolled. Clinical features, laboratory investigations, lipid profile parameters including triglycerides, HDL-C, LDL cholesterol, and total cholesterol, along with survival outcomes, were analyzed. Statistical analysis included receiver operating characteristic (ROC) analysis, survival comparison, and logistic regression modeling using SPSS version 20.0. Results: The mean age of the study population was 12.21 ± 4.28 years. Infectious etiologies accounted for all cases, with enteric fever being the most common trigger (58.3%), followed by sepsis (25.0%) and hepatitis A (16.7%). Significant lipid abnormalities were observed, particularly elevated triglyceride and reduced HDL-C levels. Mean triglyceride levels were significantly higher among non-survivors (544.78 ± 82.72 mg/dL) compared to survivors (376.99 ± 82.34 mg/dL). ROC analysis demonstrated excellent prognostic performance of triglycerides with an AUC of 0.99, while LDL cholesterol showed good predictive performance with an AUC of 0.89. Logistic regression analysis identified triglycerides, LDL cholesterol, and C-reactive protein (CRP) as significant predictors of mortality. Overall mortality in the study population was 29.2%. Conclusion: Lipid profile abnormalities are strongly associated with disease severity and mortality in pediatric secondary HLH. Triglycerides demonstrated excellent predictive performance and may serve as reliable, inexpensive prognostic biomarkers for early risk stratification in pediatric sHLH patients. Early identification of severe lipid abnormalities may facilitate timely intervention and improved clinical outcomes.

Keywords: Secondary hemophagocytic lymphohistiocytosis; pediatric HLH; lipid profile; triglycerides; HDL-C; LDL cholesterol; prognosis; mortality predictors.