Abstract / Summary
Abstract Background Hemophagocytic lymphohistiocytosis (HLH) can be secondary to tuberculosis, but its early clinical manifestations lack specificity and are easily mistaken for tuberculous toxemia symptoms or the systemic inflammatory response to active TB infection. Although serum ferritin is a core diagnostic indicator for HLH, its prognostic value in patients with pulmonary tuberculosis complicated by cytopenia (bicytopenia or pancytopenia) is still unclear. The aim of this study is to evaluate high ferritin levels as a candidate warning marker on the risk of in-hospital mortality in such patients. Method This retrospective cohort study was conducted on the clinical data of pulmonary tuberculosis patients with combined peripheral blood reduction of two or more lines admitted to our hospital from 2018 to 2025. According to serum ferritin levels, they were divided into a hyperferritinemia group (> 500 µg/L, 24 cases) and a lower-ferritin group (≤ 500 µg/L,19 cases). Compare the clinical characteristics, laboratory indicators, and in-hospital mortality rates between two groups, and use logistic regression analysis to identify the factors influencing mortality. Result Among the 43 patients, the in-hospital mortality rate in the hyperferritinemia group was significantly higher than that in the lower-ferritin group (37.50% vs. 5.26%, P = 0.026). A bar chart comparing in-hospital mortality rates further illustrated the marked difference between the two groups (37.50% vs. 5.26%). Although there was no significant difference between the two groups in conventional laboratory markers including platelet count and lactate dehydrogenase (LDH) ( P > 0.05), analysis adjusting for age showed that ferritin > 500 µg/L was associated with in-hospital mortality (OR = 10.011, 95% CI: 1.041–96.272, P = 0.046), although the wide confidence interval indicates considerable uncertainty. Conclusion In patients with pulmonary tuberculosis complicated by cytopenia (bicytopenia or pancytopenia), ferritin > 500 µg/L was associated with higher in-hospital mortality and may serve as a candidate warning marker. These findings are exploratory and hypothesis-generating, and require prospective validation. Ferritin may help identify patients who warrant closer evaluation, although this proposed strategy requires validation in larger cohorts. Clinical trial registration Not applicable.