摘要Objectives This study aimed to investigate the association between laboratory biomarkers and short-term poor prognosis in patients with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis(EBV-HLH)and to develop a risk stratification model.Methods A retrospective analysis was conducted on clinical data from 117 EBV-HLH patients admitted to our hospital between June 2016 and December 2024.Patients were classified into poor prognosis(n=48)and good prognosis(n=69)groups based on 28-day outcomes.Potential predictors were screened by univariable logistic regression and receiver operating characteristic(ROC)curve analysis,and a composite laboratory-based risk scoring system was subsequently constructed.Results The poor prognosis group exhibited significantly higher levels of urea(UREA),direct bilirubin(DB),high-sensi-tivity cardiac troponin Ⅰ(hscTnⅠ),serum ferritin(Ferr),and prothrombin time(PT)than the good prognosis group did(all P＜0.05).ROC analysis determined the optimal cutoff values and corresponding odds ratios(ORs)for poor prognosis as follows:UREA(≥5.4 mmol/L,OR=5.911),DB(≥ 10.0 μmol/L,OR=2.524),hscTnⅠ(≥7.4 pg/mL,OR=2.747),Ferr(≥ 12,422 μg/L,OR=2.366),and PT(≥ 14.1 s,OR=3.221).A 0-5-point risk score model was constructed based on these thresholds.The incidence of poor prognosis increased progressively with the score:23.08％(score 0-1),27.59％(score 2),45.00％(score 3),66.67％(score 4),and 92.30％(score 5).Each 1-point increase in the score was associated with an OR of 1.915 for poor prognosis.Conclusion The composite risk scoring system incorporating UREA,DB,hscTnⅠ,Ferr,and PT showed satisfactory predic-tive performance for short-term outcomes in EBV-HLH patients.A score of ≥3 identifies high-risk individuals who may benefit from intensified immunomodulatory therapy,thereby facilitating individualized and stratified clinical management.