P039 Audit into multi-disciplinary team care of haemophagocytic lymphohistiocytosis

Abstract Background/Aims Haemophagocytic lymphohistiocytosis (HLH) is a rare condition characterised by hyper-inflammation leading to multi-organ failure. Diverse causes mean it is challenging to identify and manage. Treating the primary driver is a principle of therapy. Recent GIRFT guidelines advise on the role of a broad MDT, including rheumatology, haematology, infectious diseases, and critical care, in management of HLH. Additionally local guidelines on causes and treatment have been in place since 2024. We undertook an audit against these standards across a large teaching hospital, focusing on the MDT input and outcomes observed. Methods Patients were identified by new HLH diagnosis between August 2022 and August 2025. Cases were manually reviewed and excluded if HLH was documented in error, patient was under age 16, or with pre-existing haematological malignancy driving illness. Data collected included admission date, diagnosis date, whether an MDT discussion was documented and if so when, escalation to critical care, organ support, outcome of illness and length of stay. Outcomes were compared based on MDT discussion. Results As seen in Table 1, 13/26 (50%) were discussions within a single specialty. 1/26 (4%) meets guideline standards. Median time from admission to MDT discussion was 10 days, with 19/26 (73%) occurring in within 14 days of admission. Overall need for organ support was 19/34 (55%). Overall mortality was 11/34 (32%). If MDT discussion occurred 14/26 (54%) needed organ support vs 5/8 (63%) if no discussion occurred. Mortality if MDT discussion occurred was 6/26 (23%) vs 5/8 (63%) if no discussion occurred. Median length of stay if survived and had MDT discussion was 52 days vs 24 days without discussion. Conclusion Low numbers mean clear conclusions are difficult. Bias from patients having classical presentations with easily identifiable causes of HLH not requiring MDT discussion is contradicted by the much lower mortality in the group that had MDT discussion. Comparable numbers requiring organ support suggests a similar level of critical illness that is not accounted for in mortality. Variation in nature of MDT makes it difficult to attribute improved mortality to MDT discussion occurring. Formal HLH MDT has since been established. Disclosure M. Regan: None. B. Parker: None.