Comment on: CD163 as a valuable diagnostic and prognostic biomarker of sepsis‐associated hemophagocytic lymphohistiocytosis in critically ill children. A call for HLA‐DR in HLH

Abstract

To the Editor: Looking for diagnostic markers, Cui et al reported on clinical and biological characteristics of a significant number of critically ill children presenting with sepsis (n = 46) or sepsis-associated hemophagocytic lymphohistiocytosis (HLH, n= 23).1 These two clinical conditions share many clinical similarities and thus remain difficult to distinguish, whereas they require urgent but opposite treatments.1 In this context, the authors are to be congratulated for the commendable analysis of several criteria and markers to establish HLH diagnosis. In particular, they measured soluble CD163 concentration and monocyte CD163 expression, two monocyte activation markers, and proposed these as additional arguments for HLH recognition. Regarding specifically HLH diagnosis, although interesting, these parameters did not seem to provide significant added values in comparison with that offered by ferritin (similar ROC curves), whereas this latter marker is a standardized routine parameter available 24/7 on automated analyzers in central/emergency laboratories. This latter aspect is of utmost importance