Utility of the HScore for Predicting COVID-19 Severity

Authors

William Hannah, HCA HealthcareFollow
Anthony Shadiack, HCA HealthcareFollow
Melissa Markofski
Kevin Dao, HCA HealthcareFollow
Eric Shaw, HCA HealthcareFollow
Craig Odum
Nayda Parisio Poldiak, HCA HealthcareFollow
Alexis Finer, HCA HealthcareFollow
Mike Flynn, HCA HealthcareFollow

Division

South Atlantic

Hospital

Grand Strand Medical Center

Document Type

Manuscript

Publication Date

11-28-2022

Keywords

covid-19 retro, anti-cytokine, cytokine storm, covid-19, hscore

Disciplines

Family Medicine | Internal Medicine | Investigative Techniques | Virus Diseases

Abstract

Background: Cytokine release syndrome is a life-threatening condition known to cause fever and multiple organ dysfunction and is suspected to be related to the severity of coronavirus disease 2019 (COVID-19). We sought to examine the utility of the HScore and non-cytokine markers of inflammation for predicting COVID-19 outcomes. We hypothesized that cytokine storm, assessed by a modified HScore, would be linked to more severe COVID-19 symptoms and higher mortality.

Methods: A retrospective review of records from a large, private hospital system was conducted on patients with hemophagocytic lymphohistiocytosis (HLH) (2014-2019) and compared to a large cohort of COVID-19-positive patients (2020). Patients with a sufficient number of elements in their record for a modified HScore calculation (n=4663), were further subdivided into population 1 (POP1, n=67; HLH, n=493 COVID-19), which had eight HScore elements, and population 2 (POP2) with six available HScore elements (POP2, n=102; HLH, n=4561 COVID-19).

Results: Modified HScore predicted COVID-19 severity in POP1 and POP2 as measured by higher odds of being on a ventilator (POP2 OR: 1.46, CI: 1.42-1.5), ICU admission (POP2 OR: 1.38, CI: 1.34-1.42), a longer length of stay (p<0.0001), and higher mortality (POP2 OR: 1.34, CI: 1.31-1.39). C-reactive protein (CRP) and white blood cell (WBC) count were the most consistent non-cytokine predictors of COVID-19 severity.

Conclusion: Cytokine storm, evaluated using a modified HScore, appeared to play a role in the severity of COVID-19 infection, and selected non-cytokine markers of inflammation were predictive of disease severity.

Publisher or Conference

Cureus

Recommended Citation

Hannah W, Shadiack A, Markofski M, et al. Utility of the HScore for Predicting COVID-19 Severity. Cureus. 2022;14(11):e31969. doi:10.7759/cureus.31969