924 Is the HScore predictive of mortality in obstetric patients admitted to the ICU with COVID-19?

Abstract

With the continuing spread of the COVID-19 pandemic, much attention has been focused on the role of cytokine storm in patients most severely affected by the virus. The HScore was developed and validated for the diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH), a condition that shares a similar cytokine profile to severe COVID-19. However, no studies have been published that specifically look at the HScore in an obstetric COVID-19 population. Our goal for this study was to evaluate the utility of the HScore in predicting mortality in obstetric patients admitted to the intensive care unit (ICU) with COVID-19. Data were collected from women enrolled in a prospective observational study to assess the impact of COVID-19 on pregnancy. HScores for women admitted to the COVID-19 ICU between April 2020 and September 2020 were calculated. Student’s t test and Fisher’s exact test were used to assess data, p<0.05 was considered significant. Data are expressed as mean±standard deviation. 15 women qualified for this study with a median age of 28 years (range 19-42) and a mean BMI of 36 kg/m2 (range 21-64). Seventy three percent of these women were Black, 13.3% were American Indian, 6.6% were Hispanic and 6.6% were White. The mean HScore was 80.3±8.3. Sixty percent of women had HScores less than 90. Mortality was not associated with HScores90 were mortalities. The remaining 4 patients with HScore>90 were discharged from the hospital. Interestingly, the two mortalities did not have the highest HScores in our cohort. Our results show that an elevated HScore was not useful for predicting mortality in obstetric patients with COVID-19 who were admitted to the ICU. However, HScore<90 was associated with survival in our patient population. Further research is needed to evaluate the effects of the COVID-19 cytokine storm in the obstetric population. Application of the Hscore in the obstetric population may be misleading given the normal physiologic laboratory changes of pregnancy.