Investigators reviewed consecutive adult SLE hospitalisations at a tertiary referral centre from 2017 to 2022. They applied Parodi criteria with a ferritin threshold >500 ng/ml to define macrophage activation syndrome (MAS). Of 623 hospitalisations in 451 patients, 86 episodes met the MAS case definition while 526 hospitalisations served as controls. The study team observed that MAS coincided with the time of SLE diagnosis in a majority of MAS episodes — 54 of 86 cases (62.9%). This finding suggests MAS frequently emerges early in the course of clinically overt disease within this cohort.
The MAS group presented with a cluster of inflammatory and hematologic abnormalities. Investigators reported higher rates of fever, hepatosplenomegaly, and lymphadenopathy among MAS cases. Cytopenias were more prevalent, and liver transaminases were elevated compared with the non-MAS hospitalised SLE group. Disease activity measured by clinical SLEDAI 2K was significantly greater in MAS (mean 13.7 ± 6.5) than in controls (mean 8 ± 5.9), with a reported p < 0.001. Serum ferritin values were markedly higher in MAS patients overall, reflecting the hyperinflammatory phenotype the authors used as part of case definition.
In-hospital deaths concentrated in the MAS cohort. The study found 13 deaths among MAS episodes (15%) versus 6 deaths in the control group (1%), and the difference reached statistical significance (p < 0.001). The cohort who died with MAS showed substantially higher mean ferritin and aspartate aminotransferase (AST) levels compared with survivors; the abstract reports mean ferritin of 12092.9 ± 2826.5 ng/ml in non-survivors versus 3993.6 ± 735 ng/ml in survivors (p < 0.001), and mean AST 544 ± 239 U/L versus 167.66 ± 27.28 U/L (p < 0.001). Neurologic and hemodynamic complications clustered with mortality: seizures (p = 0.035), altered mental status (p = 0.004), and shock (p < 0.001) were more common among fatal MAS episodes. Critical-care markers including ICU admission and mechanical ventilation also associated with higher in-hospital death (p < 0.001 for both comparisons).
The authors performed univariate and multivariate analyses, using stepwise logistic regression, to identify mortality risk factors within the MAS group. On multivariate analysis two variables remained independently associated with in-hospital death: ferritin >2400 ng/ml (odds ratio 8.1; 95% CI 1.46–44.85; p = 0.017) and seizures (odds ratio 7.3; 95% CI 1.2–44.29; p = 0.030). The abstract reports these adjusted estimates; it did not provide additional model performance metrics, calibration statistics, or alternative cut-points.
This is a retrospective study conducted at a single tertiary referral hospital. Consecutive hospitalised adult-onset SLE patients meeting Parodi criteria plus ferritin >500 ng/ml were classified as MAS; all other hospitalised SLE patients without MAS constituted the control population. Clinical, laboratory, and immunological features were compared between groups, and mortality risk factors among MAS patients were examined with univariate testing followed by multivariate stepwise logistic regression. The abstract specifies key comparative p-values and the odds ratios for the multivariate model but does not provide additional methodological details such as handling of missing data, sample-size justification, or the full list of candidate variables entered into the regression.
The information in the abstract identifies the study as retrospective and single-centre. The report did not include detailed treatment regimens administered to MAS patients, post-discharge outcomes, or external validation of the mortality predictors. Investigators did not report broader generalisability data or prospective confirmation of the ferritin cut-point of 2400 ng/ml as a prognostic threshold. These gaps remain open clinical questions that the abstract leaves unresolved and that would require prospective or multicentre data to address.
The study team concluded that MAS is an uncommon complication of active lupus, detectable by fever, elevated ferritin, raised transaminases, and cytopenia, and that it carries a markedly higher rate of in-hospital mortality. The abstract does not report therapeutic protocols nor longer-term follow-up, and those omissions limit immediate translation of the prognostic observations into standardized management algorithms.