Bone marrow haemophagocytosis indicates severe infection with severe acute respiratory syndrome coronavirus 2

Swoboda, Julia; Wittschieber, Daniel; Sanft, Juliane; Kleemann, Sandra; Elschner, Stefan; Ihle, Hannah; Hubig, Michael; Pletz, Mathias W.; Mall, Gita; Gaßler, Nikolaus

doi:10.1111/his.14281

Cited by 13 publications

(17 citation statements)

References 26 publications

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“…There is not enough evidence of what proportion of patients with COVID-19 will show hemophagocytosis in reticuloendothelial systems. It was reported in an autopsy series in fatal cases of COVID-19 that 10 out of 15 patients showed evidence of erythrophagocytosis in bone marrow smears [ 16 ]. Another autopsy report in four COVID-19 patients with diffuse alveolar damage proved lymphophagocytosis in pulmonary lymph nodes in 3 patients [ 17 ].…”

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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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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“…The presence of macrophage activation-like syndrome, an extreme phenotype of bacterial sepsis, characterized by hyperferritinemia, coagulation disorders, liver dysfunction and high mortality, is also present in severe COVID-19. (8,132,133). Meanwhile, it has been demonstrated that the host response is characterized by a dysregulated activation of the innate immune system coupled with tissue damage by neutrophils and monocytes driving the interplay of inflammation and coagulation (129,130).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 as cause of viral sepsis: A Systematic Review and Meta-Analysis

Karakike¹,

Giamarellos‐Bourboulis²,

Kyprianou³

et al. 2020

Preprint

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ImportanceCOVID-19 is a heterogenous disease most frequently causing respiratory tract infection but in its severe forms, respiratory failure and multiple organ dysfunction syndrome may occur, resembling sepsis. The prevalence of viral sepsis among COVID-19 patients is still unclear.ObjectiveWe aimed to describe this in a systematic review.Data sourcesMEDLINE(PubMed), Cochrane and Google Scholar databases were searched for studies reporting on patients hospitalized with confirmed COVID-19, diagnosed with sepsis or infection-related organ dysfunctions or receiving organ replacement therapy.Study selectionEligible were full-text English articles of randomized and non-randomized clinical trials and observational studies reporting on patients with confirmed COVID-19, who are diagnosed with sepsis or have infection-related organ dysfunctions. Systematic reviews, editorials, conference abstracts, animal studies, case reports, articles neither in English nor full-text, and studies with fewer than 30 participants were excluded.Data extraction and synthesisAll eligible studies were included in a narrative synthesis of results and after reviewing all included studies a meta-analysis was conducted. Separate sensitivity analyses were conducted per adult vs pediatric populations and per Intensive Care Unit (ICU) vs non-ICU populations.Main outcomes and measuresPrimary endpoint was the prevalence of sepsis using Sepsis-3 criteria among patients with COVID-19 and among secondary, new onset of infection-related organ dysfunction. Outcomes were expressed as proportions with respective 95% confidence interval (CI).ResultsOf 1,903 articles, 104 were analyzed. The prevalence of sepsis in COVID-19 was 39.9% (95% CI, 35.9-44.1; I2, 99%). In sensitivity analysis, sepsis was present in 25.1% (95% CI, 21.8-28.9; I2 99%) of adult patients hospitalized in non-Intensive-Care-Unit (ICU) wards (40 studies) and in 83.8 (95% CI, 78.1-88.2; I2,91%) of adult patients hospitalized in the ICU (31 studies). Sepsis in children hospitalized with COVID-19 was as high as 7.8% (95% CI, 0.4-64.9; I2, 97%). Acute Respiratory Distress Syndrome was the most common organ dysfunction in adult patients in non-ICU (27.6; 95% CI, 21.6-34.5; I2, 99%) and ICU (88.3%; 95% CI, 79.7-93.5; I2, 97%)Conclusions and relevanceDespite the high heterogeneity in reported results, sepsis frequently complicates COVID-19 among hospitalized patients and is significantly higher among those in the ICU. PROSPERO registration number: CRD42020202018. No funding.KEY POINTSQuestionWhat is the prevalence of viral sepsis by Sepsis-3 definition among hospitalized patients with COVID-19?FindingsIn this systematic review and meta-analysis, we systematically reviewed published literature for evidence of organ failure in COVID-19, to estimate the prevalence of viral sepsis in this setting, by means of SOFA score calculation. The prevalence of sepsis in COVID-19 was 39.9% (95% CI, 35.9-44.1; I2, 99%).MeaningThis is the first study to address the burden of viral sepsis in hospitalized patients with COVID-19, a highly heterogenous infection ranging from asymptomatic cases to severe disease leading to death, as reflected in the high heterogeneity of this study.

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“…The emergence of unstable hemoglobin is another feasible hypothesis, as the SARS-CoV-2 may be entering the process of hemocytopoiesis, in addition to being highly mutagenic. Such mutagenicity results from the viral capacity to store genetic information also in RNA molecules, and this is the case with the SARS-CoV-2 ( 74 , 75 ). Thus, the SARS-CoV-2 would cause mutations and generate polymorphisms.…”

Section: Clinical Exam and Proteomics: Perspectivesmentioning

confidence: 99%

Dysregulation in erythrocyte dynamics caused by SARS-CoV-2 infection: possible role in shuffling the homeostatic puzzle during COVID-19

Mendonça

Cruz

Pinheiro

et al. 2022

Hematology, Transfusion and Cell Therapy

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Introduction : The evolving COVID-19 pandemic became a hallmark in human history, not only by changing lifestyles, but also by enriching scientific knowledge on viral infection and its consequences. Objective : Although management of cardiorespiratory changes is pivotal to a favorable prognosis during severe clinical findings, dysregulation of other systems caused by SARS-CoV-2 infection may imbalance erythrocyte dynamics, such as a bidirectional positive feedback loop pathophysiology. Method and Results : Recent evidence shows that SARS-CoV-2 is capable of affecting the genetics and dynamics of erythrocytes and this coexists with a non-homeostatic function of cardiovascular, respiratory and renal systems during COVID-19. In hypothesis, SARS-CoV-2-induced systematical alterations of erythrocytes dynamics would constitute a setpoint for COVID-19-related multiple organ failure syndrome and death. Conclusion : The present review covers the most frequent erythrocyte-related non-homeostatic findings during COVID-19 capable of providing mechanistic clues of SARS-CoV-2-induced infection and inspiring therapeutic-oriented scientific evidence.

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Bone marrow haemophagocytosis indicates severe infection with severe acute respiratory syndrome coronavirus 2

Abstract: Possible Relationship between SARS‐CoV‐2 infection, bone marrow haemophagocytosis and accelerated deterioration of COVID‐19.

Cited by 13 publications

References 26 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

COVID-19 as cause of viral sepsis: A Systematic Review and Meta-Analysis

Dysregulation in erythrocyte dynamics caused by SARS-CoV-2 infection: possible role in shuffling the homeostatic puzzle during COVID-19

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