A Case series on Macrophage activation syndrome with infections. More common than we think

Introduction: Association of Macrophage activation syndrome (MAS) and infections has been documented earlier in literature however, there have been case reports and isolated cases and we did not come across a big series on above in association with infections This communication delineates a case cohort of macrophage activation syndrome secondary to infectious diseases Objectives: To study the epidemiology and pattern of common variables in a cohort of Macrophage activation syndrome associated with an infectious etiology Methods: Setting: Sixty bedded multidisciplinary ICUs of tertiary care units Methodology: Consecutive patients suspected of macrophage activation syndrome fulfilling diagnostic criteria as per HLH 2004 trial were included for a duration dated first January 2017-till date with an infectious disease etiology were included They were evaluated with a focus on demographics, SOFA scores, ALT levels, AST levels, Hemoglobin, platelet counts, serum creatinine levels, bone marrow findings, incidence of AKI, LDH levels, splenomegaly, length of stay and mortality Death/discharge from ICU were considered as end points Statistical analysis was done using SPSS version 23 Results: Total of thirty-seven patients with high grade fever were included (n=37, M: F-24:13) with age distribution of 44 8±14 3 years (Range-21-70) SOFA scores were 14 8±2 2 (Range-10-18) and length of stay (LOS) was 10 4±3 31 days (Range-5-17) Hemoglobin levels were 11 7±2 8(Range 7 9-17 5) gm/dl and platelet counts were 60324 32± 25075 50 (Range12,000 -90,000) AST and ALT levels were 164± 54 (Range-61-263) and 164 9 ± 48 7 (Range-82-247) respectively [Ref <30] Serum triglycerides, Serum ferritin levels, D-Dimer and LDH levels were 326± 34 6 mg/dl (Range-290-410), 1530 4±909 7 (Range 740-4500) ngm/ml,4000±1640 ng/ml (Range 3260-5900) and 295±15 7 (Range-190-384) units/l respectively The incidence of AKI for the entire cohort was n=17(45 9%) with serum creatinine levels 1 44± 1 08 (Range-0 5-5 8) mg/dl Bone marrow was consistent with hemophagocytosis in n=22(59 5%) In hospital mortality was n=6 (16 2%) and splenomegaly was noted in n=19(51 4%) The etiology included Dengue n=7 (18 9%), Typhoid n=10(27%), HIV n=4(14 8%), Malaria n=5 (18 5%), COVID 19 n=3(8 1%) and gram-negative infections n=8(29%) On statistical analysis only Platelet levels and Ferritin levels had an association with mortality (p value 0 0003S and 0 00001S) Conclusion: MAS remains a suspect cause in any new onset fever in ICU Its associations with infectious diseases and ability to alter outcomes should prompt an early recognition for the same This communication documents a bad prognosis with thrombocytopenia and elevated ferritin levels in these cohorts