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.
