tetano
Editor, Senior Moderator
Arthritis Rheumatol
. 2022 Dec 12.
doi: 10.1002/art.42417. Online ahead of print.
Criteria for hyperinflammation developing in coronavirus disease-19: analysis of two cohorts from different periods of the pandemic
Shirkhan Amikishiyev[SUP] 1 [/SUP], M Guven Gunver[SUP] 2 [/SUP], Murat Bektas[SUP] 1 [/SUP], Sarvan Aghamuradov[SUP] 1 [/SUP], Burak Ince[SUP] 1 [/SUP], Nevzat Koca[SUP] 1 [/SUP], Ege Sinan Torun[SUP] 1 [/SUP], Numune Aliyeva[SUP] 1 [/SUP], Selma Sari[SUP] 1 [/SUP], Cigdem Cetin[SUP] 1 [/SUP], Banu C Yalcin-Dulundu[SUP] 1 [/SUP], Rabia Deniz[SUP] 3 [/SUP], Fatih Kemik[SUP] 3 [/SUP], Besim Fazil Agargun[SUP] 3 [/SUP], Ubeyde Ayse Gulseren[SUP] 3 [/SUP], Beliz Besisik[SUP] 3 [/SUP], Onur Alkan[SUP] 3 [/SUP], Ceren Bagriacik[SUP] 3 [/SUP], Yavuz B Tor[SUP] 3 [/SUP], Naci Senkal[SUP] 3 [/SUP], Yunus Catma[SUP] 3 [/SUP], Gorkem Durak[SUP] 4 [/SUP], Sevim Mese[SUP] 5 [/SUP], Ali Agacfidan[SUP] 5 [/SUP], Murat Kose[SUP] 3 [/SUP], Mustafa Erelel[SUP] 6 [/SUP], A Atahan Cagatay[SUP] 7 [/SUP], Serap Simsek-Yavuz[SUP] 7 [/SUP], Sevgi Kalayoglu-Besisik[SUP] 8 [/SUP], Figen Esen[SUP] 9 [/SUP], Ahmet Gül[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Hyperinflammation (HI) developing in 2[SUP]nd[/SUP] week of COVID-19 contributes to the worse outcome. Because of relatively milder laboratory findings, available criteria for classification of hemophagocytic lymphohistiocytosis or macrophage activation syndrome could not be helpful.
Methods: Discovery cohort included symptomatic COVID-19 patients from Turkey, followed at hospital during the initial wave. Replication cohort consisted of hospitalized patients from a later period; all required oxygen support and received glucocorticoids. Diagnosis of HI was made by an expert panel and the majority received tocilizumab or anakinra. Daily clinical and laboratory data were recorded, and data of treatment start day were compared with the 5[SUP]-[/SUP] 6[SUP]th[/SUP] day data of other patients. Values maximizing the sensitivity and specificity of each parameter were calculated to determine criteria items.
Results: 685 patients were analyzed in discovery and 156 in replication cohorts; of whom 150 and 61 received treatment for HI, respectively. Mortality rate was higher in HI patients of discovery cohort (23.3%) compared to the rate of other patients (3.7%), and it was much lower in replication cohort for both groups. The 12-item criteria were developed to define HI of COVID-19 (HIC), and score of 35 provided 85.3% sensitivity, 81.7% specificity. The same criteria gave 90.0% sensitivity for HIC in replication cohort, but lower specificity values were observed, due to the inclusion of milder cases of HIC responding only glucocorticoids.
Conclusions: The new criteria are expected to define patients with HIC better with reasonable sensitivity and specificity and enable us to start treatment as early as possible. This article is protected by copyright. All rights reserved.
. 2022 Dec 12.
doi: 10.1002/art.42417. Online ahead of print.
Criteria for hyperinflammation developing in coronavirus disease-19: analysis of two cohorts from different periods of the pandemic
Shirkhan Amikishiyev[SUP] 1 [/SUP], M Guven Gunver[SUP] 2 [/SUP], Murat Bektas[SUP] 1 [/SUP], Sarvan Aghamuradov[SUP] 1 [/SUP], Burak Ince[SUP] 1 [/SUP], Nevzat Koca[SUP] 1 [/SUP], Ege Sinan Torun[SUP] 1 [/SUP], Numune Aliyeva[SUP] 1 [/SUP], Selma Sari[SUP] 1 [/SUP], Cigdem Cetin[SUP] 1 [/SUP], Banu C Yalcin-Dulundu[SUP] 1 [/SUP], Rabia Deniz[SUP] 3 [/SUP], Fatih Kemik[SUP] 3 [/SUP], Besim Fazil Agargun[SUP] 3 [/SUP], Ubeyde Ayse Gulseren[SUP] 3 [/SUP], Beliz Besisik[SUP] 3 [/SUP], Onur Alkan[SUP] 3 [/SUP], Ceren Bagriacik[SUP] 3 [/SUP], Yavuz B Tor[SUP] 3 [/SUP], Naci Senkal[SUP] 3 [/SUP], Yunus Catma[SUP] 3 [/SUP], Gorkem Durak[SUP] 4 [/SUP], Sevim Mese[SUP] 5 [/SUP], Ali Agacfidan[SUP] 5 [/SUP], Murat Kose[SUP] 3 [/SUP], Mustafa Erelel[SUP] 6 [/SUP], A Atahan Cagatay[SUP] 7 [/SUP], Serap Simsek-Yavuz[SUP] 7 [/SUP], Sevgi Kalayoglu-Besisik[SUP] 8 [/SUP], Figen Esen[SUP] 9 [/SUP], Ahmet Gül[SUP] 1 [/SUP]
Affiliations
- PMID: 36508470
- DOI: 10.1002/art.42417
Abstract
Background: Hyperinflammation (HI) developing in 2[SUP]nd[/SUP] week of COVID-19 contributes to the worse outcome. Because of relatively milder laboratory findings, available criteria for classification of hemophagocytic lymphohistiocytosis or macrophage activation syndrome could not be helpful.
Methods: Discovery cohort included symptomatic COVID-19 patients from Turkey, followed at hospital during the initial wave. Replication cohort consisted of hospitalized patients from a later period; all required oxygen support and received glucocorticoids. Diagnosis of HI was made by an expert panel and the majority received tocilizumab or anakinra. Daily clinical and laboratory data were recorded, and data of treatment start day were compared with the 5[SUP]-[/SUP] 6[SUP]th[/SUP] day data of other patients. Values maximizing the sensitivity and specificity of each parameter were calculated to determine criteria items.
Results: 685 patients were analyzed in discovery and 156 in replication cohorts; of whom 150 and 61 received treatment for HI, respectively. Mortality rate was higher in HI patients of discovery cohort (23.3%) compared to the rate of other patients (3.7%), and it was much lower in replication cohort for both groups. The 12-item criteria were developed to define HI of COVID-19 (HIC), and score of 35 provided 85.3% sensitivity, 81.7% specificity. The same criteria gave 90.0% sensitivity for HIC in replication cohort, but lower specificity values were observed, due to the inclusion of milder cases of HIC responding only glucocorticoids.
Conclusions: The new criteria are expected to define patients with HIC better with reasonable sensitivity and specificity and enable us to start treatment as early as possible. This article is protected by copyright. All rights reserved.