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

Abstract

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.

Development of a novel score model to predict hyperinflammation in COVID-19 as a forecast of optimal steroid administration timing

“…The cut-off value of the SP-score was 10 (AUC: 0.792; a fair discrimination, 95%CI: 0.698–0.886). Furthermore, although the H-score >169 was 93% sensitive and 86% specific for HLH, the score was not reported to be as high as HLH in patients with COVID-19 ( 8 ). Additionally, from the result of the univariate analysis ( Table 2 ), the H-score of the steroid-required group presented significantly higher scores than the steroid non-required group (62.8 ± 31.1 vs .…”

“…Comparing the H-score and SP-score parameters, both are similar in that they contain fever, AST, and ferritin levels. While several negative views on the usefulness of the H-score as a predictor of severe COVID-19 exist, opinions that the H-score can be useful if modified have also been reported ( 8 ). For example, Bordbar et al proposed that a higher H-score was associated with more ICU admissions, extended hospitalization periods, and a higher mortality rate ( 8 ).…”

“…While several negative views on the usefulness of the H-score as a predictor of severe COVID-19 exist, opinions that the H-score can be useful if modified have also been reported ( 8 ). For example, Bordbar et al proposed that a higher H-score was associated with more ICU admissions, extended hospitalization periods, and a higher mortality rate ( 8 ). Furthermore, the H-score with a new cut-off is considered more practical in predicting disease severity in patients with severe COVID-19.…”

“…Meanwhile, immunosuppression was defined as being HIV positive or receiving long-term immunosuppressive therapies ( 16 ). Since we followed the study by Bordbar et al, zero scores were recorded for those items with no available data, such as hemophagocytosis in bone marrow smears, because it was unethical to perform a bone marrow puncture when treating COVID-19 ( 8 ).…”

Hemophagocytic lymphohistiocytosis diagnosed by bone marrow trephine biopsy in living post-COVID-19 patients: case report and mini-review

“…1, f). In Bordbar et al 2021), in most cases there is a lack of COVID-19-associated sHLH criteria, such as high fever, cytopenia, and signs of abnormalities through CT scan imaging analysis. However, morphological findings such as BM aspirate may support the diagnosis of sHLH (Tholin et al 2020).…”