Objective Coronavirus disease 2019 (COVID-19) is associated with diffuse lung injury that can progress to acute respiratory distress syndrome, multisystem-organ failure, and death. The inflammatory storm seen in many COVID-19 patients closely resembles secondary hemophagocytic lymphohistiocytosis (sHLH) which has been described in other virus-associated severe sepsis. We sought to describe the incidence of sHLH in COVID-19 infected patients. Design In this retrospective study, we reviewed the records of critically ill COVID-19 positive patients to determine the incidence of sHLH. An H-score for sHLH diagnosis was determined for each study participant, with a score greater than 169 points needed for diagnosis. Setting A quaternary referral center in suburban Pennsylvania, USA. Patients All study participants had a positive COVID-19 test, and were deemed critically ill defined as receiving invasive mechanical ventilation and/or who expired. Measurements and Main Results Of the 246 records identified, 242 records met inclusion criteria and were reviewed. Eighty five patients were excluded from analysis due to missing H-score data parameters. Overall, 32 of 157 (20.38%, 95% CI:14.38-27.54%) patients met diagnostic criteria for sHLH. The average age was 69.42 years (standard deviation (SD) 14.81). Patients diagnosed with sHLH were more likely to be younger (61.09 years vs 69.38 years, P = 0.0036), male (71.88% vs 52.00%, P = 0.0433), and require mechanical ventilation (96.88% vs 72.80%, P = 0.0035). Conclusions Among critically ill COVID-19 positive patients, the incidence of sHLH is higher than previously reported in patients with non-COVID-19 related sepsis. Clinicians caring for COVID-19 patients should consider this secondary diagnosis and subsequent appropriate treatments, especially in those requiring mechanical ventilation.
【저자키워드】 COVID-19, adult respiratory distress syndrome, Retrospective studies, sars-cov-2 (severe acute respiratory syndrome coronavirus -2), severe respiratory distress syndrome, multi-viral pneumonia, incidence and prognosis, 【초록키워드】 Coronavirus disease 2019, mechanical ventilation, Diagnosis, Sepsis, Lung injury, Retrospective study, Critically ill, male, Patient, death, age, incidence, USA, secondary hemophagocytic lymphohistiocytosis, parameters, acute respiratory distress, Invasive mechanical ventilation, Analysis, COVID-19 patient, Diagnostic Criteria, Standard deviation, Non-COVID-19, average, inclusion criteria, syndrome, positive patients, inflammatory storm, positive COVID-19, COVID-19 infected patients, sHLH, measurement, objective, FIVE, setting, Result, greater, described, reported, subsequent, diagnosed, receiving, was determined, determine, All study participant, closely resemble, COVID-19 positive patient, were excluded, 【제목키워드】 hemophagocytic lymphohistiocytosis, secondary,