VAHS - Virus-associated hemophagocytic syndrome
VAHS is associated with massive cytokine release (“cytokine storm”), elevated plasma levels of soluble interleukin-2 receptor (sIL-2R)
and other inflammatory mediators, as well as accumulation of activated T-lymphocytes and macrophages in various organs, frequently resulting in multi organ failure and death [12-16].
study of 25 severely ill h1n1 patients in Germany - 12 patients died, all from multi organ failure
Overall, eight out of the nine patients (89%) with confirmed
VAHS died compared to four out of 16 (25%) without VAHS (Figure 3).
===================================================http://ccforum.com/content/pdf/cc10073.pdfVirus-associated hemophagocytic syndrome as a major contributor to death in
patients with 2009 influenza A (H1N1) infection
Virus-associated hemophagocytic syndrome (VAHS) is a severe complication of various viral infections often resulting in multi organ failure and death. The purpose of this study was to describe baseline characteristics, development of virus-associated hemophagocytic syndrome, related treatments and associated mortality rate of consecutive critically ill patients with confirmed 2009 influenza A (H1N1) infection and respiratory failure.
Virus-associated hemophagocytic syndrome developed in nine out of 25 (36%) critically ill patients with confirmed 2009 influenza A (H1N1) infection; eight of them (89%) died. In contrast, the mortality rate in the remaining 16 patients without hemophagocytic syndrome was 25% (P=0.004 for the survival difference in patients with or without hemophagocytosis by log-rank analysis). Patients were young (median, 45 [IQR, 35 to 56] years), however 18 (72%) presented one or more risk factors for severe course of illness. All 25 patients received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia with duration of mechanical ventilation of median (IQR) 19 (13 to 26) days and an additional 17 (68%) of whom required extracorporeal membrane oxygenation for median (IQR) 10 (6 to 19) days.
Findings raise the possibility that VAHS may be a frequent complication of severe 2009 influenza A (H1N1) infection and represents an important contributor to multi organ failure and death in these patients.