HScore参数与重症新型冠状病毒肺炎的关联：一项系统评价与Meta分析

Association of HScore Parameters with Severe COVID-19: A Systematic Review and Meta-Analysis.

作者信息

Hossein Kazemi Mohammad, Kuhestani Dehaghi Bentolhoda, Roshandel Elham, Bonakchi Hossein, Parkhideh Sayeh, Mehdizadeh Mahshid, Hajifathali Abbas

机构信息

Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

出版信息

Iran J Med Sci. 2021 Sep;46(5):322-338. doi: 10.30476/IJMS.2021.88404.1910.

DOI:10.30476/IJMS.2021.88404.1910

PMID:34539007

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8438337/

Abstract

BACKGROUND

Several reports have associated the severe Coronavirus disease-2019 (sCOVID-19) with secondary-hemophagocytic lymphohistiocytosis (sHLH) and proposed utilizing the hemophagocytic syndrome diagnostic score (HScore) for sCOVID-19 patients. We conducted a systematic review and meta-analysis to find the possible association of HScore parameters with severity in COVID-19 patients.

METHODS

A systematic search was performed in Medline via PubMed, EMBASE, and Cochrane databases using all HScore and COVID-19 keywords. The studies were all from 2020, and the study language was limited to English. The records were screened based on inclusion/exclusion criteria. Random/fixed-effect models were employed for meta-analysis, based on the I index of parameters. The pooled mean differences were estimated for continuous parameters. The pooled odds-ratio was estimated for fever. The level of significance was set at 0.05.

RESULTS

Eighteen studies (comprising 2459 patients) out of 26151 screened studies were included in this meta-analysis. The results showed that the level of leukocyte, neutrophil, aspartate transaminase (AST), ferritin, and fibrinogen were significantly higher in sCOVID-19 patients than in non-severe ones. Significant lower levels of lymphocyte, platelet, and hemoglobin were also found in sCOVID-19 patients than non-severe patients. Fever was nearly associated with two times increased odds of sCOVID-19 (P=0.051).

CONCLUSION

Lymphopenia, thrombocytopenia, hypohemoglobinemia, hyperferritinemia, high levels of AST, and fever are common features of both sCOVID-19 and HLH. However, the leukocytosis, neutrophilia, and hyperfibrinogenemia found in sCOVID-19 are in contrast with HScore. Conclusively, HScore parameters could be risk factors for sCOVID-19. However, some parameters' roles are contradictory, suggesting the need for further investigation and a new way of HScore interpretation in sCOVID-19 patients.A preprint of this study was published at https://www.researchsquare.com/article/rs-54490/v2.

摘要

背景

多项报告将重症2019冠状病毒病（sCOVID-19）与继发性噬血细胞性淋巴组织细胞增生症（sHLH）相关联，并提议对sCOVID-19患者使用噬血细胞综合征诊断评分（HScore）。我们进行了一项系统评价和荟萃分析，以找出HScore参数与COVID-19患者病情严重程度之间可能存在的关联。

方法

通过PubMed、EMBASE和Cochrane数据库在Medline中使用所有HScore和COVID-19关键词进行系统检索。研究均来自2020年，研究语言限于英语。根据纳入/排除标准对记录进行筛选。基于参数的I指数，采用随机/固定效应模型进行荟萃分析。对连续参数估计合并平均差。对发热估计合并比值比。显著性水平设定为0.05。

结果

在26151项筛选研究中，有18项研究（共2459例患者）纳入了本荟萃分析。结果显示，sCOVID-19患者的白细胞、中性粒细胞、天冬氨酸转氨酶（AST）、铁蛋白和纤维蛋白原水平显著高于非重症患者。sCOVID-19患者的淋巴细胞、血小板和血红蛋白水平也显著低于非重症患者。发热与sCOVID-19的患病几率增加近两倍相关（P = 0.051）。

结论

淋巴细胞减少、血小板减少、低血红蛋白血症、高铁蛋白血症、AST水平升高和发热是sCOVID-19和HLH的共同特征。然而，sCOVID-19中发现的白细胞增多、中性粒细胞增多和高纤维蛋白原血症与HScore相反。总之，HScore参数可能是sCOVID-19的危险因素。然而，一些参数的作用相互矛盾，这表明需要进一步研究以及对sCOVID-19患者的HScore解释采用新的方法。本研究的预印本发表于https://www.researchsquare.com/article/rs-54490/v2。