tetano
Editor, Senior Moderator
BMC Infect Dis
. 2021 Apr 29;21(1):398.
doi: 10.1186/s12879-021-06094-8.
Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients
Mei Meng[SUP] #[/SUP][SUP] 1 2 [/SUP], Limin Chen[SUP] #[/SUP][SUP] 1 [/SUP], Sheng Zhang[SUP] #[/SUP][SUP] 1 [/SUP], Xuan Dong[SUP] #[/SUP][SUP] 3 [/SUP], Wenzhe Li[SUP] #[/SUP][SUP] 1 2 [/SUP], Ranran Li[SUP] 1 [/SUP], Yunxin Deng[SUP] 1 2 [/SUP], Tao Wang[SUP] 1 2 [/SUP], Yan Xu[SUP] 1 2 [/SUP], Jiao Liu[SUP] 1 2 [/SUP], Yanxia Huang[SUP] 1 2 [/SUP], Yizhu Chen[SUP] 1 2 [/SUP], Sisi Huang[SUP] 1 [/SUP], Zhenliang Wen[SUP] 1 2 [/SUP], Lidi Zhang[SUP] 1 2 [/SUP], Hangxiang Du[SUP] 1 2 [/SUP], Yongan Liu[SUP] 1 2 [/SUP], Djillali Annane[SUP] 4 [/SUP], Jieming Qu[SUP] 5 6 [/SUP], Dechang Chen[SUP] 7 [/SUP]
Affiliations
Abstract
Background: Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event and a fatal complication of viral infections. Whether sHLH may also be observed in patients with a cytokine storm induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still uncertain. We aimed to determine the incidence of sHLH in severe COVID-19 patients and evaluate the underlying risk factors.
Method: Four hundred fifteen severe COVID-19 adult patients were retrospectively assessed for hemophagocytosis score (HScore). A subset of 7 patients were unable to be conclusively scored due to insufficient patient data.
Results: In 408 patients, 41 (10.04%) had an HScore ?169 and were characterized as "suspected sHLH positive". Compared with patients below a HScore threshold of 98, the suspected sHLH positive group had higher D-dimer, total bilirubin, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, serum creatinine, triglycerides, ferritin, interleukin-6, C-reactive protein, procalcitonin, lactate dehydrogenase, creatine kinase isoenzyme, troponin, Sequential Organ Failure Assessment (SOFA) score, while leukocyte, hemoglobin, platelets, lymphocyte, fibrinogen, pre-albumin, albumin levels were significantly lower (all P < 0.05). Multivariable logistic regression revealed that high ferritin (>1922.58 ng/mL), low platelets (<101 ? 10[SUP]9[/SUP]/L) and high triglycerides (>2.28 mmol/L) were independent risk factors for suspected sHLH in COVID-19 patients. Importantly, COVID-19 patients that were suspected sHLH positive had significantly more multi-organ failure. Additionally, a high HScore (>98) was an independent predictor for mortality in COVID-19.
Conclusions: HScore should be measured as a prognostic biomarker in COVID-19 patients. In particular, it is important that HScore is assessed in patients with high ferritin, triglycerides and low platelets to improve the detection of suspected sHLH.
Keywords: COVID-19; Cytokine storm; Ferritin; HScore; Platelet; Secondary Hemophagocytic Lymphohistiocytosis; Triglycerides.
. 2021 Apr 29;21(1):398.
doi: 10.1186/s12879-021-06094-8.
Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients
Mei Meng[SUP] #[/SUP][SUP] 1 2 [/SUP], Limin Chen[SUP] #[/SUP][SUP] 1 [/SUP], Sheng Zhang[SUP] #[/SUP][SUP] 1 [/SUP], Xuan Dong[SUP] #[/SUP][SUP] 3 [/SUP], Wenzhe Li[SUP] #[/SUP][SUP] 1 2 [/SUP], Ranran Li[SUP] 1 [/SUP], Yunxin Deng[SUP] 1 2 [/SUP], Tao Wang[SUP] 1 2 [/SUP], Yan Xu[SUP] 1 2 [/SUP], Jiao Liu[SUP] 1 2 [/SUP], Yanxia Huang[SUP] 1 2 [/SUP], Yizhu Chen[SUP] 1 2 [/SUP], Sisi Huang[SUP] 1 [/SUP], Zhenliang Wen[SUP] 1 2 [/SUP], Lidi Zhang[SUP] 1 2 [/SUP], Hangxiang Du[SUP] 1 2 [/SUP], Yongan Liu[SUP] 1 2 [/SUP], Djillali Annane[SUP] 4 [/SUP], Jieming Qu[SUP] 5 6 [/SUP], Dechang Chen[SUP] 7 [/SUP]
Affiliations
- PMID: 33926377
- DOI: 10.1186/s12879-021-06094-8
Abstract
Background: Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event and a fatal complication of viral infections. Whether sHLH may also be observed in patients with a cytokine storm induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still uncertain. We aimed to determine the incidence of sHLH in severe COVID-19 patients and evaluate the underlying risk factors.
Method: Four hundred fifteen severe COVID-19 adult patients were retrospectively assessed for hemophagocytosis score (HScore). A subset of 7 patients were unable to be conclusively scored due to insufficient patient data.
Results: In 408 patients, 41 (10.04%) had an HScore ?169 and were characterized as "suspected sHLH positive". Compared with patients below a HScore threshold of 98, the suspected sHLH positive group had higher D-dimer, total bilirubin, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, serum creatinine, triglycerides, ferritin, interleukin-6, C-reactive protein, procalcitonin, lactate dehydrogenase, creatine kinase isoenzyme, troponin, Sequential Organ Failure Assessment (SOFA) score, while leukocyte, hemoglobin, platelets, lymphocyte, fibrinogen, pre-albumin, albumin levels were significantly lower (all P < 0.05). Multivariable logistic regression revealed that high ferritin (>1922.58 ng/mL), low platelets (<101 ? 10[SUP]9[/SUP]/L) and high triglycerides (>2.28 mmol/L) were independent risk factors for suspected sHLH in COVID-19 patients. Importantly, COVID-19 patients that were suspected sHLH positive had significantly more multi-organ failure. Additionally, a high HScore (>98) was an independent predictor for mortality in COVID-19.
Conclusions: HScore should be measured as a prognostic biomarker in COVID-19 patients. In particular, it is important that HScore is assessed in patients with high ferritin, triglycerides and low platelets to improve the detection of suspected sHLH.
Keywords: COVID-19; Cytokine storm; Ferritin; HScore; Platelet; Secondary Hemophagocytic Lymphohistiocytosis; Triglycerides.