Attapon Cheepsattayakorn^1,3*, Ruangrong Cheepsattayakorn² and Porntep Siriwanarangsun³

¹10^th Zonal Tuberculosis and Chest Disease Center, Chiang Mai, Thailand
²Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
³Faculty of Medicine, Western University, Pathumtani Province, Thailand

*Corresponding Author: Attapon Cheepsattayakorn, 10^th Zonal Tuberculosis and Chest Disease Center, Chiang Mai, Thailand.

Received: November 16, 2021 ; Published: December 01, 2021

The first commonly clinical criteria used for the diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH) was established in the HLH-2000 study [1] and in 2014, a hemophagocytic syndrome clinical scoring system (HScore) has been developed for the diagnosis of sHLH [2,3]. For monitoring hyperinflammation (HI) in COVID-19, HScore has been proposed [4]. San., et al. demonstrated in their study on the determining the COVID-19 severity by HScore, MuLBSTA, Quick SOFA (qSOFA), Sequential Organ Failaure Assessment (SOFA), and the Brescia-COVID Respiratory Severity Scale (BCRSS) that the area under the curve (AUC) of the HScore, MuLBSTA, SOFA, qSOFA, and BRCSS were 0.698, 0.860, 0.958, 0.961, and 0.977, respectively [5]. At the time of hospital admission, the calculation of the qSOFA and BRCSS can predict COVID-19 patients’ critical clinical outcomes, and the predictive values of SOFA, MuLBSTA, and HScore are inferior to those of qSOFA and BRCSS [5]. A recent study conducted by Ardern-Jones., et al. in a small cohort that % HScore demonstrated no excess mortality compared to the whole cohort, whereas, % HScore were lower in older patients (p < 0.0001) and did not predict reliably the outcomes at any cut-off value (AUROC: 0.533, p = 0.211, Odd Ratios: 0.99) [6]. Nevertheless, severe inflammation in COVID-19 may be reflected by high HScore (at least 130) rather than sHLH, and some investigators have recommended using this score in all COVID-19 patients [2,7,8]. HScore could be affected by the large randomized control trials’ data that have modified the practice of hydroxychloroquine or lopinavir/ritonavir prescription in favor of steroid use [9,10].

References

1. Henter JI., et al. “HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis”. Pediatric Blood Cancer 48 (2007): 124-131.
2. Fardet L., et al. “Development and validation of HScore, a score for the diagnosis of reactive hemophagocytic syndrome”. Arthritis Rheumatology 66 (2014): 2613-2620.
3. La Rosée P., et al. “Recommendations for the management of hemophagocytic lymphohistiocytosis in adults”. Blood 133 (2019): 2465-2477.
4. Mehta P., et al. “COVID-19 : consider cytokine storm syndromes and immunosuppression”. Lancet 395 (2020): 1033-1034.
5. San I., et al. “Brescia-COVID Respiratory Severity Scale (BRCSS) and Quick SOFA (qSOFA) score are most useful in showing severity in COVID-19 patients”. Scientific Reports 11 (2021): 21807.
6. Ardern-Jones M., et al. “Secondary haemophagocytic lymphohistiocytosis in hospitalized COVID-19 patients as indicated by a modified HScore in infrequent and high scores do not associate with increased mortality”. Clinical Medicine5 (2021): e543-e547.
7. Takami A. “Possible role of low dose etoposide therapy for hemophagocytic lymphohistiocytosis by COVID-19”. International Journal of Hematology 112 (2021): 122-124.
8. Bordbar M., et al. “Assessment of the HScore as a predictor of disease outcome in patients with COVID-19”. BMC Pulmonary Medicine 21 (2021): 338.
9. RECOVERY Collaborative Group., et al. “Dexamethasone in hospitalized patients with COVID-19-preliminary report”. The New England Journal of Medicine 384 (2020): 693-704.
10. RECOVERY Collaborative Group., et al. “Effect of hydroxychloroquine in hospitalized patients with COVID-19”. The New England Journal of Medicine 383 (2020): 2030-2040.

Citation

Citation: Attapon Cheepsattayakorn., et al. “HScore could be a Predictor of COVID-19 Outcomes”. Acta Scientific Microbiology 5.1 (2022): 01-02.

Copyright

Copyright: © 2021 Attapon Cheepsattayakorn., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.