Hyperinflammatory Syndrome in Patients with COVID-19

Objective: The aim of this study was to investigate the relationship between the initial hyperinflammatory syndrome (HIS) risk score, calculated according to the clinical criteria recommended in the literature, and clinical outcomes in hospitalized patients with the diagnosis of coronavirus disease 2019-(COVID-19). Methods: A total of 169 patients (93 females, 76 males, mean age: 65.10 +/- 14.74 years) who were hospitalized with a polymerase chain reaction-confirmed COVID-19 diagnosis at the time of hospitalization were consecutively enrolled in this retrospective, observational and clinical study. Those with two or more of the characteristics of fever, macrophage activation, haematological dysfunction, hepatic injury, coagulopathy, and cytokinemia constituted the group with high risk of HIS, and those with <2 constituted the group with low risk of HIS. Groups were compared according to their clinical characteristics and outcomes. Results: There were 109 (64.5%) patients with a baseline HIS score of =2, and 60 (35.5%) patients with a baseline HIS score of <2. Mean length of stay (15.25 +/- 9.61 vs. 9.53 +/- 5.39, p<0.01), intensive care unit (ICU) admission (38.2% vs. 1.7%, p<0.01) mechanical ventilation need (MVN) (31.2% vs.1.7%, p<0.01) and mortality (24.8% vs. 0%, p<0.01) were higher in the HIS score =2 group than the HIS score <2 group. HIS score =2 increased the risk of ICU admission [odds ratio (OR) =36.5; 95% confidence interval (CI) =4.862], and the risk of MVN (OR =26.747; 95% CI =3.557) Conclusion: The HIS score =2 at the time of hospitalization was associated with the increased risk of ICU admission, MVN and mortality. Initial HIS risk assessment in patients with COVID-19 could be useful to predict the prognosis and to select patients for immunomodulatory therapy.