A serum ferritin level above 4420 ng/ml identifies in a reliable and very specific way the septic patient with macrophage activation-like syndrome (MALS).

Since the recent subgroup analysis indicated a survival benefit from anakinra treatment among patients with MALS, it is plausible that the use of ferritin can identify potential candidates for such a personalized immunotherapy approach in sepsis.

The frequency of MALS was 3.7% and 4.3% in the test and the validation cohort, respectively. In both cohorts, MALS was an independent risk factor for 10-day mortality.

A ferritin level above 4420 ng/ml was accompanied by 66.7% and 66% mortality after 28 days, respectively.

Patients with infections and systemic inflammatory response syndrome were assigned to one test cohort (n = 3417) and a validation cohort (n = 1704).

MALS was diagnosed for patients scoring positive either for the hemophagocytic syndrome score and/or having both hepatobiliary dysfunction and disseminated intravascular coagulation.

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