Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Curr Med Sci. 2021 Feb;41(1):39-45. doi: 10.1007/s11596-021-2315-4. Epub 2021 Feb 13.
Infection-associated hemophagocytic syndrome (IAHS), a severe complication of various infections, is potentially fatal. This study aims to determine whether IAHS occurs in critically ill patients with coronavirus disease 2019 (COVID-19). We conducted a retrospective observational study on 268 critically ill patients with COVID-19 between February 1st, 2020 and February 26th, 2020. Demographics, clinical characteristics, laboratory results, information on concurrent treatments and outcomes were collected. A diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH) was made when the patients had an HScore greater than 169. Histopathological examinations were performed to confirm the presence of hemophagocytosis. Of 268 critically ill patients with confirmed SARS-CoV-2 infection, 17 (6.3%) patients had an HScore greater than 169. All the 17 patients with sHLH died. The interval from the onset of symptom of COVID-19 to the time of a diagnosis of sHLH made was 19 days and the interval from the diagnosis of sHLH to death was 4 days. Ten (59%) patients were infected with only SARS-CoV-2. Hemophagocytosis in the spleen and the liver, as well as lymphocyte infiltration in the liver on histopathological examinations, was found in 3 sHLH autopsy patients. Mortality in sHLH patients with COVID-19 is high. And SARS-CoV-2 is a potential trigger for sHLH. Prompt recognition of IAHS in critically ill patients with COVID-19 could be beneficial for improving clinical outcomes.
感染相关噬血细胞综合征（IAHS）是各种感染的严重并发症，具有潜在致命性。本研究旨在确定冠状病毒病 2019（COVID-19）危重症患者是否会发生 IAHS。我们对 2020 年 2 月 1 日至 2 月 26 日期间的 268 例 COVID-19 危重症患者进行了回顾性观察性研究。收集了人口统计学、临床特征、实验室结果、同时进行的治疗信息和结局。当患者的 H 评分大于 169 时，诊断为继发性噬血细胞性淋巴组织细胞增生症（sHLH）。进行组织病理学检查以确认存在噬血细胞现象。在 268 例确诊 SARS-CoV-2 感染的危重症患者中，17 例（6.3%）患者的 H 评分大于 169。所有 17 例 sHLH 患者均死亡。从 COVID-19 症状发作到 sHLH 诊断的时间间隔为 19 天，从 sHLH 诊断到死亡的时间间隔为 4 天。10 例（59%）患者仅感染 SARS-CoV-2。3 例 sHLH 尸检患者的组织病理学检查发现脾脏和肝脏噬血细胞现象以及肝脏淋巴细胞浸润。COVID-19 合并 sHLH 患者的死亡率较高。SARS-CoV-2 可能是 sHLH 的潜在触发因素。在 COVID-19 危重症患者中及时识别 IAHS 可能有助于改善临床结局。
