RT Journal Article SR Electronic(1) A1 Alam, Fiaz A1 Becetti, Karima A1 Alamlih, Laith A1 Cackamvalli, Priyanka A1 Veettil, Safna A1 Awadh, Basem A1 Ibrahim, Mohamed A1 Al Emadi, SamarYR 2022 T1 Rate of secondary HLH and performance of H-score in patients with severe COVID-19 JF Qatar Medical Journal, VO 2022 IS 2 - First allergy conference in Qatar OP SP 11 DO https://doi.org/10.5339/qmj.2022.fqac.11 PB Hamad bin Khalifa University Press (HBKU Press), SN 2227-0426, AB Background: Severe COVID-19 is thought to be caused by immune overdrive and cytokine storm. One of the cytokine storm syndromes frequently induced by infections is secondary hemophagocytic lymphohistiocytosis (HLH) which can be assessed using H-score. In this study, we aimed to evaluate the rate of patients with COVID-19 who meet HLH criteria based on H-score and the association of H-score with poor outcomes. Methods: In a prospective cohort study of 19 patients with COVID-19 requiring ICU stay from March to May, 2020, we collected demographic and clinical data that focused on H-score's variables and COVID-19 outcomes. H-score ≥ 169 was used to determine the percentage of patients who met the HLH criteria. Mann-Whitney, Kruskal-Wallis, and Spearman rho tests and multiple regression analyses were carried out to evaluate the associated factors. The optimal H-score cut-off to predict poor COVID-19 outcome (need for intubation ± ECMO) was determined using receiver operating characteristic (ROC) analysis. Results: In 669 patients with severe COVID-19 with a mean ± SD age of 50.3 ± 12.8 years, which comprised 95% men; 66% required intubation, 4% ECMO, and 16% died. Only 2% had an H-score ≥ 169. Patients with poor outcomes had a higher mean (SD) H-score than those without; intubation (96.0 [50.0] vs 75.0 [35.0], p < 0.01), ECMO (113.0 [25.0] vs 93.0 [50.0], p < 0.01) and death (98.0 [62.0] vs 93.0 [48.0], p < 0.01). Factors associated with H-score were diabetes (β coeff = − 10.4, p < 0.01), abdominal pain (β coeff = 19.1, p < 0.01), duration of COVID-19 symptoms (β coeff = − 0.7, p = 0.049), and days before ICU admission (β coeff = − 1.2, p = 0.01). H-score showed a fair ability to discriminate COVID-19 outcomes (AUC 0.61, 95% CI 0.54–0.67). An H-score of 85 was the optimal cut-off with a sensitivity 69% and 1-specificity 53%. Conclusion: Despite its association with severity in COVID-19, H-score's ability to predict poor outcomes was only fair, indicating differences in the cytokine storm faced in COVID-19 compared with that during secondary HLH., UL https://www.qscience.com/content/journals/10.5339/qmj.2022.fqac.11