---
title: "Macrophage activation syndrome in lupus linked to markedly higher in-hospital mortality"
id: "pubmed-42912419"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42912419"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42912419/"
doi: "10.1177/09612033261500970"
published_at: "2026-10-23T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Macrophage activation syndrome in lupus linked to markedly higher in-hospital mortality
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42912419
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42912419/)
- **DOI:** [10.1177/09612033261500970](https://doi.org/10.1177%2F09612033261500970)
- **Published At:** 2026-10-23T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The authors conducted a retrospective review at a tertiary referral centre covering 2017–2022; adult-onset SLE hospitalisations were screened for **macrophage activation syndrome** (MAS) using Parodi criteria with ferritin >500 ng/ml. - Among 623 hospitalisations in 451 patients, 86 episodes met MAS definition and 526 hospitalisations served as controls; MAS occurred at SLE presentation in 54 of the 86 MAS cases (62.9%). - The MAS cohort presented more often with fever, hepatosplenomegaly, lymphadenopathy, cytopenias, and raised transaminases; clinical SLEDAI 2K scores were higher (mean 13.7 ± 6.5 vs 8 ± 5.9, p 2400** ng/ml (OR 8.1; 95% CI 1.46–44.85; p = 0.017) and seizures (OR 7.3; 95% CI 1.2–44.29; p = 0.030) as independent mortality-associated variables in MAS. - The study team concluded MAS is an uncommon but severe complication of active **lupus**, characterized by fever, hyperferritinaemia, transaminitis and cytopenias, and associated with high in-hospital mortality. - The report is a single-centre retrospective analysis; the abstract did not report detailed treatment protocols, longer-term outcomes after discharge, or external validation of the findings.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Macrophage activation syndrome is associated with high in-hospital mortality in patients with lupus [Benzeeta Pinto](https://pubmed.ncbi.nlm.nih.gov/?term=Pinto+B&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#full-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Kodali Ramya Sri](https://pubmed.ncbi.nlm.nih.gov/?term=Ramya+Sri+K&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#full-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Girish Narayan](https://pubmed.ncbi.nlm.nih.gov/?term=Narayan+G&cauthor_id=42912419)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#full-view-affiliation-2 "Department of Emergency Medicine, St John's Medical College Hospital, Bengaluru, India."), [Ramya Janardana](https://pubmed.ncbi.nlm.nih.gov/?term=Janardana+R&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#full-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Mohammad Salih Salim](https://pubmed.ncbi.nlm.nih.gov/?term=Salim+MS&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#full-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Anna C Das](https://pubmed.ncbi.nlm.nih.gov/?term=Das+AC&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#full-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Vineeta Shobha](https://pubmed.ncbi.nlm.nih.gov/?term=Shobha+V&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#full-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India.") Affiliations Expand ### Affiliations * 1 Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India. * 2 Department of Emergency Medicine, St John's Medical College Hospital, Bengaluru, India. * PMID: **42912419** * DOI: [ 10.1177/09612033261500970 ](https://doi.org/10.1177/09612033261500970) Item in Clipboard # Macrophage activation syndrome is associated with high in-hospital mortality in patients with lupus Benzeeta Pinto et al. Lupus. 2026. Show details Display options Display options Format Abstract PubMed PMID Lupus Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Lupus%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Lupus%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42912419/) . 2026 Oct 23:9612033261500970. doi: 10.1177/09612033261500970. Online ahead of print. ### Authors [Benzeeta Pinto](https://pubmed.ncbi.nlm.nih.gov/?term=Pinto+B&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#short-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Kodali Ramya Sri](https://pubmed.ncbi.nlm.nih.gov/?term=Ramya+Sri+K&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#short-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Girish Narayan](https://pubmed.ncbi.nlm.nih.gov/?term=Narayan+G&cauthor_id=42912419)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#short-view-affiliation-2 "Department of Emergency Medicine, St John's Medical College Hospital, Bengaluru, India."), [Ramya Janardana](https://pubmed.ncbi.nlm.nih.gov/?term=Janardana+R&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#short-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Mohammad Salih Salim](https://pubmed.ncbi.nlm.nih.gov/?term=Salim+MS&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#short-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Anna C Das](https://pubmed.ncbi.nlm.nih.gov/?term=Das+AC&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#short-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India."), [Vineeta Shobha](https://pubmed.ncbi.nlm.nih.gov/?term=Shobha+V&cauthor_id=42912419)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42912419/#short-view-affiliation-1 "Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India.") ### Affiliations * 1 Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bengaluru, India. * 2 Department of Emergency Medicine, St John's Medical College Hospital, Bengaluru, India. * PMID: **42912419** * DOI: [ 10.1177/09612033261500970 ](https://doi.org/10.1177/09612033261500970) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract ObjectiveTo study the clinical features and outcomes of macrophage activation syndrome in lupus.MethodsThis was a retrospective study conducted in a tertiary care referral centre from 2017 to 2022. Consecutive hospitalised adult-onset SLE patients diagnosed with MAS, fulfilling the Parodi criteria with ferritin >500 ng/ml were included. All the other hospitalised SLE patients without MAS served as controls. Clinical and immunological features and in-hospital mortality was compared between the 2 groups. Risk factors for mortality in MAS patients were determined performing univariate and multivariate analyses with a stepwise logistic regression.ResultsOf 623 hospitalisations in 451 SLE patients, 86 met the case definition for MAS and 526 served as controls. MAS occurred at the time of SLE diagnosis in 54 (62.9%). MAS was associated with fever, hepatosplenomegaly, lymphadenopathy, cytopenia, and elevated transaminases. Disease activity (clinical SLEDAI 2K) was significantly higher in MAS (mean 13.7 ± 6.5 vs. 8 ± 5.9 (_p_ 2400{OR-8.1 95% CI: (1.46-44.85) _p_ - 0.017} and seizures {OR-7.3 95% CI: (1.2-44.29) _p_ - 0.030} were associated with mortality in MAS.ConclusionsMAS is a rare complication of active lupus identified by fever, elevated ferritin, liver transaminases and cytopenia and is associated with high in hospital mortality. **Keywords:** ferritin; haemophagocytosis; lupus; macrophage activation syndrome; mortality. 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