Abstract
Severe coronavirus disease 2019 (COVID-19) accompanies hypercytokinemia, similar to secondary hemophagocytic lymphohistiocytosis (sHLH). We aimed to find if HScore could predict disease severity in COVID-19. HScore was calculated in hospitalized children and adult patients with a proven diagnosis of COVID-19. The need for intensive care unit (ICU), hospital length of stay (LOS), and in-hospital mortality were recorded. The median HScore was 43.0 (IQR 0.0–63.0), which was higher in those who needed ICU care (59.7, 95% CI 46.4–72.7) compared to those admitted to non-ICU medical wards (38.8, 95% CI 32.2–45.4; P = 0.003). It was also significantly higher in patients who died of COVID-19 (105.1, 95% CI 53.7–156.5) than individuals who survived (41.5, 95% CI 35.8–47.1; P = 0.005). Multivariable logistic regression analysis revealed that higher HScore was associated with a higher risk of ICU admission (adjusted OR = 4.93, 95% CI 1.5–16.17, P = 0.008). The risk of death increased by 20% for every ten units increase in HScore (adjusted OR 1.02, 95% CI 1.00–1.04, P = 0.009). Time to discharge was statistically longer in high HScore levels than low levels (HR = 0.41, 95% CI 0.24–0.69). HScore is much lower in patients with severe COVID-19 than sHLH. Higher HScore is associated with more ICU admission, more extended hospitalization, and a higher mortality rate. A modified HScore with a new cut-off seems more practical in predicting disease severity in patients with severe COVID-19.
Highlights
Secondary hemophagocytic lymphohistiocytosis is a life-threatening severe systemic hyperinflammatory syndrome characterized by hypercytokinemia with multi-organ dysfunction
Recent literature by Zhou et al indicates that severe coronavirus disease 2019 (COVID-19) accompanies by an aggressive inflammatory response known as a cytokine storm [2], that bears similarities to Secondary hemophagocytic lymphohistiocytosis (sHLH) (including excess production of tumor necrosis factor-α (TNF- α), monocyte chemoattractant protein-1 (MCP1), and interleukin-2 [IL-2])
Hypothesizing that the cytokine storm is the principal cause of disease severity in patients with COVID-19, and considering the controversies in the literature regarding the potential of HScore, as an index of cytokine storm, to predict the severity of COVID-19, our study aimed to investigate whether and how HScore is associated with the need for intensive care unit (ICU) care, hospital length of stay (LOS), and in-hospital mortality in confirmed cases of COVID-19
Summary
Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening severe systemic hyperinflammatory syndrome characterized by hypercytokinemia with multi-organ dysfunction. Recent literature by Zhou et al indicates that severe coronavirus disease 2019 (COVID-19) accompanies by an aggressive inflammatory response known as a cytokine storm [2], that bears similarities to sHLH (including excess production of tumor necrosis factor-α (TNF- α), monocyte chemoattractant protein-1 (MCP1), and interleukin-2 [IL-2]). The probability of sHLH can be predicted by a validated score called HScore [3]. A score higher than 169 was shown to predict the risk of sHLH with 93% sensitivity and 86% specificity [4]. Mehta and colleagues hypothesized that HScore might detect hyperinflammatory states in patients with severe COVID-19. The use of HScore for COVID- 19 patients has remained questionable by some
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