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ORIGINAL RESEARCH article

Front. Pediatr.
Sec. Pediatric Rheumatology
Volume 12 - 2024 | doi: 10.3389/fped.2024.1469912

Increased ferritin, serum lactate dehydrogenase, and aspartate aminotransferase levels predict macrophage activation syndrome complicating systemic lupus erythematosus: A retrospective study

Provisionally accepted
Haiguo Yu Haiguo Yu *Yingying Liu Yingying Liu Yuting Pan Yuting Pan Jing Jin Jing Jin Panpan Wang Panpan Wang Tonghao Zhang Tonghao Zhang Zhidan Fan Zhidan Fan
  • Department of Rheumatology and Immunology, Nanjing Children's Hospital, Nanjing, China

The final, formatted version of the article will be published soon.

    Background: This study aimed to assess the diagnosis of macrophage activation syndrome (MAS) at the onset of active childhood-onset systemic lupus erythematosus (cSLE), which is under researched, and to compare the characteristics of cSLE with and without MAS, hypothesizing the existence of possible predictors of MAS in active cSLE. Methods: This study enrolled 157 patients diagnosed with cSLE, with or without MAS, from Nanjing Medical University between January 2018 and May 2023. Data analysis was performed using an independent samples t-test or the Mann–Whitney U-test, the X2 test, the Youden index to determine the optimal cutoff values for diagnosis, and binary logistic regression analysis to determine the predicted probability Results: Fifteen patients (9%) had MAS in the active phase, with an SLE disease activity index of 16.6 (range: 6–32). Bone marrow aspirations revealed hemophagocytosis in 8/15 cases (53%). Fever was the most common feature of MAS patients. Lactate dehydrogenase and ferritin levels were elevated in the patients. Lower leukocyte, neutrophil, and platelet counts, including serum sodium and fibrinogen, and increased alanine aminotransferase, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), ferritin, triglyceride, and D-dimer levels occurred in MAS patients, unlike those without MAS. Optimal cutoff values for ferritin (≥607.35 ng/mL), LDH (≥ 424 U/L), and AST (≥ 61 U/L) were predictors of MAS occurrence in cSLE. No MAS patients experienced recurrence during an 18 month mean follow-up. Conclusions: Despite the narrow study scope, elevated ferritin, LDH and AST levels may represent indicators of cSLE complicated by MAS. Early diagnosis and treatment may improve outcomes.

    Keywords: ferritin, Lactate dehydrogenase, aspartate aminotransferase, childhood-onset systemic lupus erythematosus, Macrophage Activation Syndrome

    Received: 24 Jul 2024; Accepted: 25 Nov 2024.

    Copyright: © 2024 Yu, Liu, Pan, Jin, Wang, Zhang and Fan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Haiguo Yu, Department of Rheumatology and Immunology, Nanjing Children's Hospital, Nanjing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.