# Reduced splenic volume and advanced age predict sepsis in patients with Howell–Jolly bodies: a retrospective cohort study

## TL;DR

This study finds that older age and smaller spleen size in patients with Howell-Jolly bodies increase the risk of sepsis.

## Contribution

The study identifies reduced splenic volume and advanced age as independent predictors of sepsis in non-splenectomized patients with Howell-Jolly bodies.

## Key findings

- Age ≥ 65 years and spleen volume < 34 mL independently predict sepsis in patients with Howell-Jolly bodies.
- Computed tomography-based spleen volume measurements can help identify functional hyposplenism.
- Older age also predicts any infection, while low spleen volume shows a trend toward significance.

## Abstract

Functional hyposplenism, defined as impaired splenic function in the absence of splenectomy, increases susceptibility to life-threatening infections. Although Howell–Jolly bodies (HJBs) are well-established markers for this condition, the predictive value of spleen volume for infection risk remains unclear. We retrospectively analyzed 95 non-splenectomized patients with HJBs from 2014 to 2024. We measured spleen volume by computed tomography and compared results with ideal values. We evaluated the associations between splenic volume and infections using univariate and multivariate logistic regression analyses. The median patient age was 66 years (range, 16−95); 72% were male. The median spleen volume was 34 mL, lower than the ideal median of 210 mL. Forty-eight percent of patients experienced at least one infection. Univariate analysis identified age ≥ 65 years and spleen volume < 34 mL as significantly associated with sepsis. Both factors remained independent predictors in multivariate analysis (age ≥ 65: odds ratio [OR], p = 0.039; spleen volume < 34 mL: OR 3.0, p = 0.047). Age ≥ 65 also predicted any infection (OR 3.1, p = 0.013), while low spleen volume demonstrated a trend toward significance (OR 2.2, p = 0.064). In non-splenectomized patients with HJBs, reduced spleen volume and older age independently increase susceptibility to sepsis. Computed tomography-based measurements may help identify functional hyposplenism and guide targeted prophylactic measures.