Title : To determine the prevalence of Covid 19 – associated Hyperinflammatory syndrome (cHIS) in hospitalized patients with SARS – CoV 2 infection and to correlate the cHIS with the severity and clinical outcome
Abstract:
Background: COVID-19, a global pandemic declared by WHO on March 11, 2020, has been linked to hyperinflammatory responses mediated by cytokine storms. The COVID-19 virus directly infects the macrophages and monocytes via ACE-2 receptors, leading to a hyperinflammatory syndrome which shares similarities with secondary HLH, macrophage activating syndrome (MAS) and cytokine release syndrome (CRS). Morbidity and mortality in COVID-19 patients has been linked to the presence of “COVID-19 associated hyperinflammatory syndrome (cHIS)” induced by the virus.
Aims and Objectives – 1) To determine the prevalence of cHIS in hospitalized patients with SARS-COV2 infection. 2) To correlate the cHIS with the severity and clinical outcome in patients of SARS-COV2 infection
Methods: This observational retrospective-prospective study was conducted at Christian Medical College, Ludhiana, on 975 hospitalized COVID-19 patients from 1st April 2020 to 30th November 2021. Patients were categorized based on oxygen saturation (SpO2) into mild, moderate, severe, and critical cases. The cHIS score (≥2 considered significant) was calculated using laboratory markers like neutrophilic lymphocyte ratio (NLR), AST, ALT, CRP, serum LDH, ferritin and D-dimer. D-dimer was available via either qualitative or quantitative method (semi quantitative or quantitative method). Statistical analysis evaluated correlations between cHIS scores and patient outcomes.
Results:
•The prevalence of cHIS (score ≥2) was 74.87%, with increasing prevalence in more severe cases:
- Moderate: 87.92%
- Severe: 95.15%
- Critical: 100%
•Males (69.40%) and patients with comorbidities (71.64%) had a higher incidence of cHIS.
•Fever (75.9%) was the most common symptom and diabetes was the commonest comorbidity (47.17%).
•CRP levels of >15 mg/dl was the most sensitive (94.93%) parameter and ferritin values of > 700ug/dl was the most specific (98.36%) parameter for calculating cHIS scores.
•Higher cHIS scores were linked to increased oxygen therapy requirements:
- 89.53% patients with cHIS score 0 did not need oxygen therapy.
- 55.88% patients with cHIS score 6 required intubation and mechanical ventilation.
•The mean hospital stay was 10.38 days for patients with cHIS versus 7.13 days for those without.
•Among patients with cHIS scores of 0–1, only 1.75% expired, whereas all patients with a cHIS score of 6 died.
•Patients with higher cHIS had worse clinical outcome as compared to those without cHIS. (p-value = <0.001)
Conclusion: In this study of 975 patients, cHIS scores correlated with the clinical severity and outcome of the COVID-19 infection. The use of the cHIS score using simple laboratory parameters would be a good tool to predict the clinical course and outcome of patients with COVID-19 infection. However, this study should be interpreted in the context of important limitations that the cHIS score was not calculated in real time.
