{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:46:52Z","timestamp":1777312012585,"version":"3.51.4"},"reference-count":0,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,4]]},"abstract":"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.<\/jats:p>\n 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\u00a0\u2265\u00a0169 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\u00a0\u00b1\u00a0ECMO) was determined using receiver operating characteristic (ROC) analysis.<\/jats:p>\n \n Results: In 669 patients with severe COVID-19 with a mean\u00a0\u00b1\u00a0SD age of 50.3\n \u00a0\u00b1\u00a0<\/jats:italic>\n 12.8 years, which comprised 95% men; 66% required intubation, 4% ECMO, and 16% died. Only 2% had an H-score\u00a0\u2265\u00a0169. 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\u00a0<\u00a00.01), ECMO (113.0 [25.0] vs 93.0 [50.0], p\u00a0<\u00a00.01) and death (98.0 [62.0] vs 93.0 [48.0], p\u00a0<\u00a00.01). Factors associated with H-score were diabetes (\u03b2 coeff =\u00a0\u2212\u00a010.4, p\u00a0<\u00a00.01), abdominal pain (\u03b2 coeff =\u00a019.1, p\u00a0<\u00a00.01), duration of COVID-19 symptoms (\u03b2 coeff =\u00a0\u2212\u00a00.7, p\u00a0=\u00a00.049), and days before ICU admission (\u03b2 coeff\u00a0=\u00a0\u2212\u00a01.2, p\u00a0=\u00a00.01). H-score showed a fair ability to discriminate COVID-19 outcomes (AUC 0.61, 95% CI 0.54\u20130.67). An H-score of 85 was the optimal cut-off with a sensitivity 69% and 1-specificity 53%.\n <\/jats:p>\n 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.<\/jats:p>","DOI":"10.5339\/qmj.2022.fqac.11","type":"journal-article","created":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T03:30:32Z","timestamp":1649907032000},"source":"Crossref","is-referenced-by-count":2,"title":["Rate of secondary HLH and performance of H-score in patients with severe COVID-19"],"prefix":"10.5339","volume":"2022","author":[{"given":"Fiaz","family":"Alam","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: FAlam1@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karima","family":"Becetti","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: FAlam1@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laith","family":"Alamlih","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: FAlam1@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priyanka","family":"Cackamvalli","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: FAlam1@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Safna","family":"Veettil","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: FAlam1@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basem","family":"Awadh","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: FAlam1@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Qatar University, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samar","family":"Al Emadi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: FAlam1@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","container-title":["Qatar Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2022\/2\/article-11.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2022\/2\/article-11.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2022\/2\/article-11.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:10:26Z","timestamp":1777309826000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2022\/2\/article-11.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,4]]},"references-count":0,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.5339\/qmj.2022.fqac.11","relation":{},"ISSN":["2227-0426"],"issn-type":[{"value":"2227-0426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,4]]}}}