Pediatric COVID-19-Associated Hyperinflammation Score: The VIRUS Registry Predictive Analytic Study
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Worldwide Data, Infection, Pediatrics, 2022
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INTRODUCTION: Several adult and pediatric studies demonstrate a correlation between elevated inflammatory markers and COVID-19 disease severity. The Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry was used to develop Pediatric COVID Hyperinflammation Syndrome (PcHIS) score and evaluate the association between PcHIS and severe COVID illness in children. METHODS: Children under 18 years of age hospitalized due to COVID-19 were filtered from VIRUS registry (NCT 04323787). Neonates and children incidentally positive for COVID were excluded. For the development of PcHIS score we used 7 variables: fever, hematologic dysfunction (platelet, leucocyte count), elevated ferritin, elevated D-dimer, cytokinemia (CRP, procalcitonin, IL-6), hepatic injury (ALT, AST, albumin) and elevated cardiac enzymes (BNP, Troponin). ROC curves were generated for each variable to choose the best discriminatory (J point of Youden Index) value for identification of severe disease (anyone requiring respiratory support more than O2 by NC, vasoactive meds, ECMO, or dialysis). Each abnormal value got one point and the additive PcHIS score was calculated for the best discriminatory score for identification of severe disease (using ROC). RESULTS: Out of a total of 1123 patients aged < 18 years with COVID-19 in the registry, 722 were included for PcHIS development; rest had missing data. A 1/3rd in the cohort had severe COVID disease. Odds of severe disease were higher with fever > 39ºC (OR1.5;CI1.05-2.14), presence of any hematologic dysfunction (platelets < 250k/µL or WBC > 6650/µL) (OR 7.12;CI 2.52-20.05), cytokinemia (CRP >6.7 mg/dL or procalcitonin > 3.4) (OR 4.99;CI 3.05-8.17), ferritin level > 270 mg/dL (OR 3.87;CI 2.38-6.28), elevated cardiac enzymes (BNP > 685 or Troponin > 0.03) (OR 3.08;CI1.96-4.85), hepatic injury (AST >50 or ALT >40 or albumin < 3.5 g/dL) (OR 3.25;CI 2.16-5.0), D-dimer > 2000 ng/ml (OR 2.46;CI1.59-3.8). A PcHIS score of 2.5 had a sensitivity of 69.2% and a specificity of 62.1% with ROC area under curve of 0.70 (95% CI: 0.66-0.74; p < 0.001).  CONCLUSIONS: PcHIS score may be calculated from early laboratory data and is useful in predicting severe disease in children with COVID-19. Its role in clinical practice needs to be determined in a prospective study.
Meta Tag
Content Type Presentation
Knowledge Area Infection
Knowledge Area Pediatrics
Knowledge Area Worldwide Data
Knowledge Level Advanced
Membership Level Select
Tag Epidemiology Outcomes
Tag Pediatrics
Tag COVID-19
Tag Infectious Diseases
Year 2022
Pediatric COVID-19 Elevated Hyperinflammation Score
severity of COVID-19 in children
clinical and laboratory markers
organ dysfunction


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