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Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients

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  • معلومة اضافية
    • Contributors:
      Shanghai Jiao Tong University Shanghai; Ruijin Hospital Shanghai, Chine; Wuhan Jinyintan Hospital Wuhan, China (WJH); Service médical des soins intensifs CHU Raymond Poincaré; Hôpital Raymond Poincaré AP-HP; Infection et inflammation (2I); Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM); The study was supported by grants from the Shanghai Science and Technology Commission, China (No. 20Y11901700, No. 20DZ2200500) and a grant from the Shandong Science and Technology Commission, China (No. ZR2019MH016).
    • بيانات النشر:
      HAL CCSD
      BioMed Central
    • الموضوع:
      2021
    • Collection:
      Inserm: HAL (Institut national de la santé et de la recherche médicale)
    • نبذة مختصرة :
      International audience ; 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 × 109/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.
    • Relation:
      info:eu-repo/semantics/altIdentifier/pmid/33926377; inserm-03313682; https://inserm.hal.science/inserm-03313682; https://inserm.hal.science/inserm-03313682/document; https://inserm.hal.science/inserm-03313682/file/s12879-021-06094-8.pdf; PUBMED: 33926377; PUBMEDCENTRAL: PMC8084265
    • الرقم المعرف:
      10.1186/s12879-021-06094-8
    • الدخول الالكتروني :
      https://inserm.hal.science/inserm-03313682
      https://inserm.hal.science/inserm-03313682/document
      https://inserm.hal.science/inserm-03313682/file/s12879-021-06094-8.pdf
      https://doi.org/10.1186/s12879-021-06094-8
    • Rights:
      http://creativecommons.org/licenses/by/ ; info:eu-repo/semantics/OpenAccess
    • الرقم المعرف:
      edsbas.5A7082B5