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 9 /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.
【저자키워드】 COVID-19, Cytokine storm, ferritin, Platelet, secondary hemophagocytic lymphohistiocytosis, triglycerides, HScore, 【초록키워드】 SARS-CoV-2, coronavirus, Risk factors, Mortality, severe COVID-19, Infection, interleukin-6, C-reactive protein, D-dimer, procalcitonin, Platelets, lactate dehydrogenase, viral infections, Hemophagocytosis, lymphocyte, Patient, Triglyceride, Aspartate aminotransferase, Logistic regression, fibrinogen, SOFA, hemoglobin, incidence, assessment, threshold, patients, prognostic biomarker, COVID-19 patients, COVID-19 patient, alanine aminotransferase, leukocyte, patient data, Blood urea nitrogen, serum creatinine, acute respiratory syndrome, total bilirubin, failure, life-threatening, multi-organ failure, fatal complication, independent risk factor, positive, significantly lower, sHLH, Hyperinflammatory, secondary, independent, IMPROVE, Result, evaluate, significantly more, characterized, determine, subset, albumin level, scored, severe COVID-19 patient, 【제목키워드】 Patient, Factor, severe coronavirus disease,