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Objective <p>To develop and validate a prognostic model for predicting 30-day mortality in older patients with hemophagocytic lymphohistiocytosis (HLH).</p> Methods <p>This retrospective cohort study enrolled 204 HLH patients aged ≥ 65 years from January 2015 to November 2023. We divided the cohort into development and validation cohorts in a 7:3 ratio. Then we used logistic regression analysis and the least absolute shrinkage and selection operator regression (LASSO) to develop a prognostic model. Performance was assessed using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA).</p> Results <p>The 30-day mortality rate was 40.7%. Multivariate analysis identified five risk factors independently associated with 30-day mortality of older patients with HLH: Age, platelet (PLT), alanine aminotransferase (ALT), UREA, and ferritin. The model has good discrimination and calibration ability (AUC: 0.828 (0.755–0.886) for the development cohort and 0.773 (0.654–0.891) for the validation cohort). The model showed excellent calibration and clinical utility. Kaplan-Meier survival curve analysis showed that patients with the nomogram value &gt; 0.3851 were positively correlated with higher 30-day mortality (<i>P</i> &lt; 0.001).</p> Conclusion <p>The model incorporating age and four routine clinical parameters accurately stratifies 30-day mortality risk in older HLH patients demonstrating strong discriminative ability and clinical applicability, thereby providing a basis for clinical decision-making.</p>

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Development and internal validation of a nomogram for predicting 30-day mortality in older patients with hemophagocytic lymphohistiocytosis

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  • 发表日期：

    2026年5月21日

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  • Jun Zhou,
  • Jingping Liu,
  • Hua Yin,
  • Mingjun Xie,
  • Hua-Guo Xu

摘要

Objective

To develop and validate a prognostic model for predicting 30-day mortality in older patients with hemophagocytic lymphohistiocytosis (HLH).

Methods

This retrospective cohort study enrolled 204 HLH patients aged ≥ 65 years from January 2015 to November 2023. We divided the cohort into development and validation cohorts in a 7:3 ratio. Then we used logistic regression analysis and the least absolute shrinkage and selection operator regression (LASSO) to develop a prognostic model. Performance was assessed using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA).

Results

The 30-day mortality rate was 40.7%. Multivariate analysis identified five risk factors independently associated with 30-day mortality of older patients with HLH: Age, platelet (PLT), alanine aminotransferase (ALT), UREA, and ferritin. The model has good discrimination and calibration ability (AUC: 0.828 (0.755–0.886) for the development cohort and 0.773 (0.654–0.891) for the validation cohort). The model showed excellent calibration and clinical utility. Kaplan-Meier survival curve analysis showed that patients with the nomogram value > 0.3851 were positively correlated with higher 30-day mortality (P < 0.001).

Conclusion

The model incorporating age and four routine clinical parameters accurately stratifies 30-day mortality risk in older HLH patients demonstrating strong discriminative ability and clinical applicability, thereby providing a basis for clinical decision-making.