PMC8403039_01
H-score calculator (H-score calculator redraw ()): the probability of HLH increases with the increase of score. The best cutoff value was 169, which corresponds to an accuracy of 90% (sensitivity of 93%, specificity of 86%). In this case report, patient presented a H-index of 229 points (96-99% of probability).
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fig1
This was further reinforced by the H-score, which strongly suggested an acute HLH most likely triggered by septic shock due to the active cancer (Figure 1); bone marrow aspirate could not be obtained at this stage.
Temporal evolution of clinical and biological data: temporal evolution of IFN-gamma, interleukin (IL) 6 and IL8 cytokines' serum values, biological data like ferritin, C-reactive protein (CRP), and clinical data such as Glasgow Coma Scale (GCS). Days refer to the day of ICU treatment. Shaded blue areas are the days of CytoSorb  adsorbent application through CVVHDF.
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fig2
From the start of the extracorporeal blood purification therapy, the patient's clinical and biochemical parameters improved, including creatinine (from 100 to 57 mumol/L, Table 1); the patient regained consciousness (GCS 14/15) allowing endotracheal tube removal and complete norepinephrine cessation together with albumin replacement; inflammatory biomarker levels also improved (Table 1 and Figure 2), especially IFNgamma (from 14.9 to 3.8 ng/mL, -74.5%), IL-8 (from 1137 to 497 pg/mL, -56.29%), IL-6 (from 183.4 to 30.6 pg/mL, -83.32%), ferritin (from 12209 to 9616 ng/mL, -21.24%), and C reactive protein (CRP from 343 to 108 mg/L, -68.51%). Table 1 and Figure 2). The sudden worsening and the already compromised patient's clinical conditions prevented any further therapeutic approach with the hemoadsorption treatment.