Evaluation of Outcome in Patients With Moderate and Severe COVID-19 Via H-Score
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 12 No. 4 (2022),
Background: Due to uncontrolled lymphocyte reaction, the overproduction of cytokines in COVID-19 patients can cause sepsis-like symptoms, suggesting sepsis, cytokine release syndrome (CRS), and secondary hemophagocytic lymphohistiocytosis (sHLH). Since different therapeutic approaches are used for each diagnosis, differentiation is essential. This study aims to use H-score as a possible prognostic tool in COVID-19 patients.
Methods: A sample of 64 moderate and severe COVID-19 patients was enrolled in this study. Clinical and laboratory findings were assessed. H-score was initially calculated and reevaluated among severe cases 72 hours later and among moderate cases showing severe features of COVID-19.
Results: Mortality of 31.3% was reported. Laboratory findings, including triglycerides (TG), ferritin, and aspartate aminotransferase (AST) showed significantly higher initial and follow-up laboratory assessment levels in severe cases than in moderate cases. Moreover, fibrinogen was significantly higher among severe cases than moderate cases at the initial assessment, but no significant difference was reported in the second fibrinogen assessment.
Conclusion: In this study, H-score was useful as a predictive tool for the initial evaluation of severe cases of COVID-19. H-score is much lower in these patients than in non-COVID-19 HLH patients may be due to the different underlying immunologic pathophysiology of COVID-19; thus, each H-score criterion must be evaluated for sensitivity and specificity in COVID-19 patients. The H-score cut-offs, H-score may be useful for diagnosing immune overreaction and determining the need for more exclusive immunomodulatory treatments.
- Hemophagocytic lymphohistiocytosis
How to Cite
World Health Organization (WHO). WHO coronavirus (COVID-19) dashboard 2022. Geneva: World Health Organization; 2022. [Link]
Cappanera S, Palumbo M, Kwan SH, Priante G, Martella LA, Saraca LM, et al. When does the cytokine storm begin in COVID-19 patients? A quick score to recognize it. Journal of Clinical Medicine. 2021; 10(2):297. [DOI:10.3390/jcm10020297] [PMID] [PMCID]
Gürsoy B, Sürmeli CD, Alkan M, Satıcı C, Altunok ES, Kamat S, et al. Cytokine storm in severe COVID-19 pneumonia. Journal of Medical Virology. 2021; 93(9):5474-80. [DOI:10.1002/jmv.27068] [PMID] [PMCID]
Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv. 2021. [DOI:10.1101/2020.11.27.20240051]
Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19. The Journal of Infection. 2020; 80(6):607-13. [DOI:10.1016/j.jinf.2020.03.037] [PMID] [PMCID]
Kazemi MH, Dehaghi BK, Roshandel E, Bonakchi H, Parkhideh S, Mehdizadeh M, et al. Association of hscore parameters with severe COVID-19: A systematic review and meta-analysis. Iranian Journal of Medical Sciences. 2021; 46(5):322-38. [DOI:10.30476/IJMS.2021.88404.1910][PMID][PMCID]
Chu R, van Eeden C, Suresh S, Sligl WI, Osman M, Cohen Tervaert JW. Do COVID-19 infections result in a different form of secondary hemophagocytic lymphohistiocytosis. International Journal of Molecular Sciences. 2021; 22(6):2967. [DOI:10.3390/ijms22062967] [PMID] [PMCID]
Clark KEN, Nevin WD, Mahungu T, Lachmann H, Singh A. Assessment of the hemophagocytic lymphohistiocytosis HScore in patients with coronavirus disease 2019. Clinical Infectious Diseases. 2021; 73(9):e3110-2. [DOI:10.1093/cid/ciaa1463] [PMID] [PMCID]
Meng QF, Tian R, Long H, Wu X, Lai J, Zharkova O, et al. Capturing cytokines with advanced materials: A potential strategy to tackle COVID-19 cytokine storm. Advanced Materials. 2021; 33(20):2100012. [DOI:10.1002/adma.202100012] [PMID] [PMCID]
NIH COVID-19 treatment guidelines panel. Clinical spectrum of sars-cov-2 infection 2021. In: COVID-19 treatment guidelines panel, editor. Coronavirus disease 2019 (COVID-19) treatment guidelines. New York: NIH COVID-19 treatment guidelines panel. [Link]
Loscocco GG. Secondary hemophagocytic lymphohistiocytosis, HScore and COVID-19. International Journal of Hematology. 2020; 112(1):125-6. [DOI:10.1007/s12185-020-02895-w] [PMID] [PMCID]
Lorenz G, Moog P, Bachmann Q, La Rosée P, Schneider H, Schlegl M, et al. Title: Cytokine release syndrome is not usually caused by secondary hemophagocytic lymphohistiocytosis in a cohort of 19 critically ill COVID-19 patients. Scientific Reports. 2020; 10(1):18277. [DOI:10.1038/s41598-020-75260-w] [PMID] [PMCID]
Ardern-Jones MR, Stammers M, Phan HTT, Borca F, Koutalopoulou A, Teo Y, et al. Secondary haemophagocytic lymphohistiocytosis in hospitalised COVID-19 patients as indicated by a modified HScore is infrequent and high scores do not associate with increased mortality. Clinical Medicine Journal (London). 2021; 21(5):E543-7. [DOI:10.7861/clinmed.2021-0053] [PMID] [PMCID]
Meng M, Chen L, Zhang S, Dong X, Li W, Li R, et al. Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients. BMC Infectious Diseases. 2021; 21(1):398. [DOI:10.1186/s12879-021-06094-8] [PMID] [PMCID]
Bordbar M, Sanaei Dashti A, Amanati A, Shorafa E, Mansoori Y, Dehghani SJ, et al. Assessment of the HScore as a predictor of disease outcome in patients with COVID-19. BMC Pulmonary Medicine. 2021; 21(1):338. [DOI:10.1186/s12890-021-01706-0] [PMID] [PMCID]
Bhattacharjee S, Banerjee M, Pal R. COVID-19 associated hemophagocytic lymphohistiocytosis and coagulopathy: Targeting the duumvirate. Indian Pediatrics. 2020; 57(9):827-33. [DOI:10.1007/s13312-020-1962-z] [PMID] [PMCID]
Greco GF, Spreafico F, Di Costanzo D, Pecoriello A, Garuti M, Inglese F, et al. Hemophagocytic lymphohistiocytosis in a patient with acute respiratory distress syndrome secondary to sars-cov-2 infection. Journal of Medical Cases. 2020; 11(10):327-9. [DOI:10.14740/jmc3515] [PMID] [PMCID]
Caricchio R, Gallucci M, Dass C, Zhang X, Gallucci S, Fleece D, et al. Preliminary predictive criteria for COVID-19 cytokine storm. Annals of the Rheumatic Diseases. 2021; 80(1):88-95. [DOI:10.1136/annrheumdis-2020-218323] [PMID]
Hakim NN, Chi J, Olazagasti C, Liu JM. Secondary hemophagocytic lymphohistiocytosis versus cytokine release syndrome in severe COVID-19 patients. Experimental Biology and Medicine (Maywood, NJ). 2021; 246(1):5-9. [DOI:10.1177/1535370220962043] [PMID] [PMCID]
Gualdoni GA, Hofmann GA, Wohlfarth P, Winkler H-M, Winkler S, Haslacher H, et al. Prevalence and outcome of secondary hemophagocytic lymphohistiocytosis among SIRS patients: Results from a prospective cohort study. Journal of Clinical Medicine. 2019; 8(4):541. [DOI:10.3390/jcm8040541] [PMID] [PMCID]
- Abstract Viewed: 332 times
- pdf Downloaded: 191 times