A Kidney Transplant Recipient With Coronavirus Disease 2019: Utility of a Prognostication Score

Adrogué, A.H.; Mithani, Farhan; Ibrahim, Hassan N.; Schwartz, Mary R.; Gaber, Lillian W.; Hebert, Sean A.; Adrogué, Horacio E.

doi:10.1016/j.transproceed.2020.08.041

Cited by 6 publications

(4 citation statements)

References 11 publications

(14 reference statements)

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“…Child cases (16 years old and younger), and suspected or unproven HLH cases were not included in the study. We found 21 more adult cases diagnosed with COVID-19-associated HLH in addition to ours [9][10][11][12][13][14][15][16][17][18][19]. Eighteen (86%) of the patients were over the age of 50 (range 17-84), 16 (76%) were male, and most of them had at least one underlying disease.…”

Section: Review Of Other Covid-19 Associated Hlh Casesmentioning

confidence: 52%

A case of Hemophagocytic lymphohistiocytosis induced by COVID-19, and review of all cases reported in the literature

Kayaaslan

Asilturk

Eser

et al. 2021

J Infect Dev Ctries

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Novel coronavirus infections 2019 (COVID-19) associated hyperinflammatory syndromes are well-defined clinical conditions and have a potential risk for severe infection. Hemophagocytic lymphohistiocytosis (HLH), a rare type of acute progressive hyperinflammatory syndrome, has been reported in a limited number of COVID-19 cases. In this article, we aimed to present a patient with HLH secondary to COVID-19 diagnosed by bone marrow biopsy, and to summarize and review HLH cases associated with COVID-19 in the literature. A 47-year-old male patient presented with complaints of fever, cough, abdominal discomfort, and nausea-vomiting. He had recovered from COVID-19 a month ago and was readmitted to the hospital due to the re-appearance of clinical symptoms after a two-week interval. The patient was diagnosed with HLH secondary to COVID-19 on sixth day of admission and fully recovered with systemic pulse steroid, intravenous immunoglobulin, and plasma exchange therapy. Analysis of literature searches revealed that 22 cases were definitely diagnosed with COVID-19-associated HLH, 16 of them were male. They had been treated with different anti-cytokine drugs, of which nine had died. The increasing number of HLH cases, which have high mortality rates, shows the importance of hyperinflammatory syndromes in COVID-19 patients. Some patients may experience hemophagocytosis in the late period of COVID-19, even while in recovery. Increased awareness and early treatment for HLH triggered by COVID-19 can be a life-saving effort for reducing mortality in severe COVID-19 cases.

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Section: Review Of Other Covid-19 Associated Hlh Casesmentioning

confidence: 52%

A case of Hemophagocytic lymphohistiocytosis induced by COVID-19, and review of all cases reported in the literature

Kayaaslan

Asilturk

Eser

et al. 2021

J Infect Dev Ctries

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“…1 . Most included studies were case reports (n=89) [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] ...…”

Section: Resultsunclassified

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

Quante

Brake

Tolios

et al. 2021

Transplantation Proceedings

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Background : The SARS-CoV-2 pandemic is challenging health systems all over the world. Particularly high-risk groups show considerable mortality rates after infection. In 2020, an inexorable number of case reports, case series and ultimately various systematic reviews have been published reporting on morbidity and mortality risk of SARS-CoV-2 in solid organ transplant (SOT) recipients. However, this vast array of publications resulted in an increasing complexity of the field, overwhelming even the expert reader. Methods : We performed a structured literature review comprising electronic databases, transplant journals and included literature from previous systematic reviews covering the entire year 2020. From 164 included articles we identified 3451 cases of SARS-CoV-2 infected SOT recipients. Results : Infections resulted in a hospitalization rate of 84% and 24% intensive care unit admissions (ICU) in the included patients. Whereas 53.6% of patients were reported to have recovered, cross-sectional overall mortality reported after COVID-19 was at 21.1%. Synoptic data concerning immunosuppressive medication attested to the reduction or withdrawal of antimetabolites (81.9%) and calcineurin inhibitors (48.9%) as a frequent adjustment. In contrast, steroids were reported to be increased in 46.8% of SOT patients. Conclusions : COVID-19 in SOT recipients is associated with high morbidity and mortality worldwide. Conforming with current guidelines, modifications of immunosuppressive therapies mostly comprised a reduction or withdrawal of antimetabolites and calcineurin inhibitors, while frequently maintaining or even increasing steroids. Here, we provide an accessible overview to the topic and synoptic estimates of expectable outcomes regarding in-hospital mortality of SOT patients diseased with COVID-19.

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“…Some researchers successfully treated their patients with severe COVID-19 and high HScore (≥ 169) with immunomodulatory agents such as anakinra and tocilizumab [ 20 – 24 ]. Given that such a high score is rarely encountered in SARS-Cov2 infection, we may consider treating patients with cytokine release syndrome using IL-1 blockers even with lower HScore.…”

Section: Discussionmentioning

confidence: 99%

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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A Kidney Transplant Recipient With Coronavirus Disease 2019: Utility of a Prognostication Score

Cited by 6 publications

References 11 publications

A case of Hemophagocytic lymphohistiocytosis induced by COVID-19, and review of all cases reported in the literature

A case of Hemophagocytic lymphohistiocytosis induced by COVID-19, and review of all cases reported in the literature

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

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

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