HScore as a Predictor for Severe COVID-19 Outcomes

An Iranian study assessed whether HScores predicted outcomes in severe COVID-19 and could thus be used to guide early treatment decisions.

HScores, typically used to assess probability of secondary hemophagocytic lymphohistiocytosis (HLH), were also predictive for COVID-19 outcomes, according to the results of a recent study published in the journal BMC Pulmonary Medicine.

This prospective cohort study recruited participants with COVID-19 from 5 hospitals in Shiraz, Southern Iran. HScores were calculated from laboratory data and associations were evaluated between HScores and patient outcomes. The primary study outcome was ICU care, while secondary outcomes included length of hospital stay and in-hospital mortality.

Among the 193 patients with COVID-19 included in the study, 49.2% were female and the median age was 47 years. A total of 52 patients required ICU care during the study period, while 9 patients died. The median HScore was higher in those who needed ICU care compared to those who were not admitted to the ICU. Additionally, HScore was also significantly higher in patients who died of COVID-19 than individuals who survived. The risk of death increased by 20% for every ten units increase in HScore.

Although HScore in patients with severe COVID-19 was associated with higher rates of ICU admission, extended hospitalization, and mortality, the study authors noted that HScores for patients with severe COVID-19 were still much lower than those of patients with HLH, which is predicted by an HScore higher than 169. Even the 9 study participants who died of COVID-19 had a mean HScore of 105.1, they noted. The investigators therefore concluded that a modified HScore with a new cut-off might offer a practical approach for predicting disease severity in patients with severe COVID-19.

“HScore may help to decide which patients may benefit from immune-modulators such as high-dose steroid, interleukin (IL)-1, or IL-6 blockade by anakinra or tocilizumab,” the study authors noted, adding that future studies of HScores for COVID-19 with larger sample sizes are needed “to determine the most appropriate cut-off point of HScore to predict prognosis of COVID-19.”


Bordbar M, Sanaei Dashti A, Amanati A, et al. Assessment of the HScore as a predictor of disease outcome in patients with COVID-19. BMC Pulm Med. 2021;21(1):338. doi:10.1186/s12890-021-01706-0

This article originally appeared on Pulmonology Advisor