Comparison of scoring systems for COVID-19 hyperinflammation and HLH
| Clinical parameter | cHIS criteria78 | HLH score* (value, points)79 |
| Fever | Temperature >38.0°C | <38.4°C, 0 points 38.4°C–39.4°C, 33 points >39.4°C, 49 points |
| Macrophage activation | Ferritin concentration >700 µg/L | Ferritin concentration <2000 ng/mL, 0 points 2000–6000 ng/mL, 35 points >6000 ng/mL, 50 points |
| Cytokinemia | Triglycerides >150 mg/dL -OR- CRP >15 pg/dL IL-6 >15 mg/dL | Triglycerides <1.5 mmol/L, 0 points 1.5–4.0 mmol/L, 44 points >4.0 mmol/L, 64 points |
| Hematological dysfunction | NLR ≥10 Hemoglobin ≤92 g/L Platelets ≤110×109 | Cytopenias One lineage, 0 points Two lineages, 24 points Three lineages, 34 points |
| Hepatic injury | Aspartate aminotransferase >100 U/L -OR- LDH >400 U/L | Aspartate aminotransferase <30 IU/L, 0 points ≥30 IU/L, 19 points |
| Coagulopathy | D-dimer >1.5 μg/mL | Fibrinogen >2.5 g/L, 0 points ≤2.5 g/L, 30 points |
*HLH score also assigns points for organomegaly (23 for hepatomegaly or splenomegaly and 38 for hepatomegaly and splenomegaly), hemophagocytosis on bone marrow aspirate (0 if no and 35 if yes), and known immunosuppression such as long-term steroids or HIV (0 if no and 18 if yes).
cHIS, COVID-19 hyperinflammatory state; CRP, C reactive protein; HLH, hemophagocytic lymphohistiocytosis; LDH, lactate dehydrogenase; NLR, neutrophil to lymphocyte ratio.