COVID-19 Associated Hemophagocytic Lymphohistiocytosis and Coagulopathy: Targeting the Duumvirate

Bhattacharjee, Sukrita; Banerjee, Mainak; Pal, Rimesh

doi:10.1007/s13312-020-1962-z

Cited by 23 publications

(19 citation statements)

References 39 publications

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“…Fifth, hypertriglyceridemia as a result of lipoprotein lipase inhibition by TNF-α is not usually reported in COVID-19. Finally, though serum ferritin is increased in viral infections, including SARS-Cov2 infection, it rarely raises more than 2000 ng/ml except in the final stages of the disease [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, HScore may help to decide which patients may benefit from immune-modulators such as high-dose steroid, interleukin (IL)-1, or IL-6 blockade by anakinra or tocilizumab [ 5 ]. However, the use of HScore for COVID- 19 patients has remained questionable by some authors due to limitations regarding body temperature, raised ferritin levels (in early phase ferritin concentrations hardly reach the HScore threshold of 2000 ng/mL), leukopenia (the HScore is unable to distinguish between lymphocytopenia and neutropenia), and the lack of published data on characteristic features [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the HScore as a predictor of disease outcome in patients with COVID-19

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of the HScore as a predictor of disease outcome in patients with COVID-19

et al. 2021

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“…However, we did not find this score to be an independent predictor for severe disease in multivariate analysis. In a study by Bhattacharjee et al, it was stated that the HScore can be used to determine the time to initiate immunotherapy in patients with severe COVID-19 infection 6,32 . A recent study showed that high HScore values were more indicative of MAS patients than severe COVID-19 patients (201.9 ± 15.3 vs. 88.8 ± 48.3, p < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

Brescia-COVID Respiratory Severity Scale (BRCSS) and Quick SOFA (qSOFA) score are most useful in showing severity in COVID-19 patients

Şan

Gemcioğlu

Başer

et al. 2021

Sci Rep

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In this study, we compare the predictive value of clinical scoring systems that are already in use in patients with Coronavirus disease 2019 (COVID-19), including the Brescia-COVID Respiratory Severity Scale (BCRSS), Quick SOFA (qSOFA), Sequential Organ Failure Assessment (SOFA), Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension, and Age (MuLBSTA) and scoring system for reactive hemophagocytic syndrome (HScore), for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians. We classified the patients into two groups according to the stage of the disease (severe and non-severe) and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 h. Of the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR 6.1, 95% CI 2.105–17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR 4.757, 95% CI 1.438–15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively. Calculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. Our prediction is that early interventions for high-risk patients, with early identification of high-risk group using BRCSS and qSOFA, may improve clinical outcomes in COVID-19.

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“…An important drug that its administration may be associated with thrombocytopenia is heparin __ which is usually prescribed to COVID-19 patients as prophylaxis for thrombosis [110] . When it comes to heparin and thrombocytopenia, the first mechanism is the induction of heparin-induced thrombocytopenia (HIT).…”

Section: Pathophysiology For Thrombocytopenia In Covid-19mentioning

confidence: 99%

Platelets in the perspective of COVID-19; pathophysiology of thrombocytopenia and its implication as prognostic and therapeutic opportunity

Delshad

Safaroghli‐Azar

Pourbagheri‐Sigaroodi

et al. 2021

International Immunopharmacology

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COVID-19 Associated Hemophagocytic Lymphohistiocytosis and Coagulopathy: Targeting the Duumvirate

Cited by 23 publications

References 39 publications

Assessment of the HScore as a predictor of disease outcome in patients with COVID-19

Assessment of the HScore as a predictor of disease outcome in patients with COVID-19

Brescia-COVID Respiratory Severity Scale (BRCSS) and Quick SOFA (qSOFA) score are most useful in showing severity in COVID-19 patients

Platelets in the perspective of COVID-19; pathophysiology of thrombocytopenia and its implication as prognostic and therapeutic opportunity

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