Background/Purpose: Adult Onset Still’s Disease (AOSD) is an autoinflammatory disease characterized by quotidian fever, arthralgia, and a salmon colored rash. Due to its rarity, there is a dearth of knowledge regarding this patient population, clinical presentation, complications, and outcomes.

Methods: Data was collected retrospectively from the Hospital Corporation of America database from 2016 to 2021. Adult patients with a diagnosis of AOSD and without other autoimmune diseases were included in the study. On these subjects, characteristics such as gender and age were collected as well as clinical information such as presenting laboratory values, outcomes, and complications were analyzed.

Results: There were 185 subjects included in this study, 69.7% were women and 67.6% were white in race (Table 1). About 10% of subjects were on home biologic medications prior to presentation. Initial laboratory findings included mean white blood cell count of 12.84 +/- 6.91, ESR 55.60 +/- 39.26, CRP 16.66 +/- 42.77, ferritin 6,793.06 +/- 11,012.50, ALT 81.85 +/- 164.93, and AST 97.83 +/- 264.52 (Table 2). Forty-four subjects were admitted to the Intensive Care Unit (ICU). While there is no statistically significant difference in those who were admitted to the ICU and not admitted in initial CRP and ESR values, there is a statistically significant difference in initial ferritin. Those who had to be admitted to the ICU had an initial ferritin 5,974.597 units higher (p=0.048). Subjects who had hemophagocytic lymphohistiocytosis (HL) (p=0.001), disseminated intravascular coagulation (DIC) (p=0.013), pleural effusions (p < 0.001) had a statistically significant frequency of being admitted to the ICU; whereas those with pericarditis, hemolytic anemia, and acute respiratory distress syndrome (ARDS) did not (Table 3).

Conclusion: The demographic results of white women being at highest risk for disease is consistent with current data. Similarly, the laboratory results of having leukocytosis, transaminitis, and elevated inflammatory markers are also consistent with prior studies. As only 6 subjects passed, admission to the intensive care unit (ICU) was used as a surrogate for morbidity from complications. Admission to the ICU was statistically associated with having a higher ferritin; however, ferritin was only collected in 92 subjects. While the average increase was about 6,000 units higher, this is likely an underestimate as the maximum laboratory value is 40,000. The complications of HL, DIC, and pleural effusions were associated with admission to the ICU, while pericarditis, hemolytic anemia, and ARDS were not. As those with AOSD tend to have delayed diagnosis and poor outcomes as a result, it is paramount that more studies are done to aid in management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-between-initial-ferritin-and-complications-from-adults-onset-stills-disease-and-intensive-care-unit-admission/