Assessment of the Hemophagocytic Lymphohistiocytosis HScore in Patients With Coronavirus Disease 2019

Journal article

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

Authors: Clark, KEN; Nevin, WD; Mahungu, T; Lachmann, H; Singh, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: Clinical Infectious Diseases
• Volume: 73
• Issue: 9
• Pages: e3110-e3112
• Publication date: 2020-09-24
• DOI: 10.1093/cid/ciaa1463
• EISSN: 1537-6591
• ISSN: 1058-4838
• Language: English
• Keywords: Internal medicine; Pediatrics; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Coronavirus; Coronavirus disease 2019 (COVID-19); 2019-20 coronavirus outbreak; Parallels; Disease; Medicine; Hemophagocytic lymphohistiocytosis; Virology; Immunology; Infectious disease (medical specialty); Pandemic