Objective:To explore the clinical characteristics of early death in adult patients with hemophagocytic syndrome (HPS).Methods:The clinical data of 53 adult HPS patients in Xianning Central Hospital, Huangshi Central Hospital and Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from September 2016 to November 2021 were retrospectively analyzed, and the patients were grouped according to whether they died within 28 d after diagnosis. The clinical characteristics of the two groups were compared. A multivariate analysis of patients' death within 28 d was performed using logistic regression.Results:In 53 adult HPS patients, the mortality rate within 28 d was 28.3% (15/53). The survival time of patients was related to white blood cell count ( r = 0.324, P = 0.018), total bilirubin level ( r = -0.280, P = 0.042) and albumin level ( r = 0.281, P = 0.042), but there was no linear causality (all P > 0.05). When compared between the death within 28 d group and the non-death within 28 d group, the differences in patients' age, platelet count, albumin level, creatine kinase isoenzyme level, triacylglycerol level, ferritin level, and central nervous system involvement were statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that platelet count <30×10 9/L, albumin <30 g/L, central nervous system involvement, and ferritin &ge;10 000 ng/ml were independent risk factors for patients' death within 28 d (all P < 0.05). Conclusions:In adult HPS patients, assessing the risk of early death based on ferritin level, platelet count, albumin level, and neurological symptoms, actively correcting internal environmental disturbances, and enhancing organ support therapy can contribute to survival benefit.