Table 1.
Classification criteria for COVID-cytokine storm
| Temple [28▪] | cHIS [29▪] | COV-HI [30▪] | |
| Sample size (n) | |||
| Derivation cohort | 513 | 299 | 269 |
| Validation cohort | Yes (258) | Yes | No |
| Clinical/Imaging | |||
| Fever | – | >38 °C | – |
| Ground-glass opacities chest imaging | CT (or X-ray)∗ | – | – |
| Laboratory | |||
| Ferritin (ng/mL) | >250∗ | 700 | >1500 |
| CRP (mg/L) | >46∗ | ≥150 | >150 |
| IL-6 (pg/mL) | – | ≥15 | – |
| Triglyceride (mg/dL) | – | ≥150 | – |
| Neutrophil: lymphocyte ratio | – | ≥10 | – |
| Hb (g/dL) | – | ≤9.2 | – |
| Platelets (×109 cells/L) | – | ≤110 | – |
| d-dimer (μg/ml) | >4.9 | ≥1.5 | – |
| LDH (U/L) | >416 | ≥400 | – |
| Aspartate transaminase (AST) (U/L) | >87 | ≥100 | – |
| Alanine transaminase (ALT) (U/L) | >60 | – | |
| Troponin I (ng/mL) | >1.09 | – | – |
| Albumin (g/dl) | <2.8 | – | – |
| Lymphocytes (%) | <10.2 | – | – |
| Neutrophil Abs (K/mm3) | >11.4 | – | – |
| Anion gap (nmol/L) | <6.8 | – | – |
| Chloride (nmol/L) | >106 | – | – |
| Potassium (nmol/L) | >4.9 | – | – |
| Blood urea nitrogen: creatinine ratio | >29 | – | – |
| Fulfilment of criteria | |||
| Interpretation: | ∗Entry criteria (orange) ground glass opacities on CT chest (or radiograph) AND elevated ferritin and CRP) with ≥1 variable from each of 3 clusters: cluster 1 (low albumin, low lymphocytes, high neutrophils); cluster 2 (elevated alanine aminotransferase, aspartate aminotransferase, D-dimer, LDH, troponin I); cluster 3 (low anion gap, high chloride, high potassium, high blood urea nitrogen:creatinine ratio). | ≥2 from 6 criteria encompassing fever, macrophage activation, haematological dysfunction, coagulopathy, hepatic injury and cytokinaemia (including CRP concentration) | ≥1 of CRP > 150 mg/L (or daily doubling from > 50 mg/L) or Ferritin > 1500 μg/L |
cHIS, COVID-19-associated hyperinflammatory syndrome; CT, computed tomography.
Table showing three studies aiming to define subgroups of COVID-19 patients with associated cytokine storm/hyperinflammation and worsening outcomes, including essential (asterix) and possible (bold) criteria. The Temple criteria includes essential criteria (ground glass opacities on chest imaging, elevated ferritin and CRP) with one or more of the following criteria from three clusters. Cluster 1 (low albumin, low lymphocytes, high neutrophils); cluster 2 (elevated alanine aminotransferase, aspartate aminotransferase, D-dimer, LDH, troponin I); cluster 3 (low anion gap, high chloride, high potassium, high blood urea nitrogen:creatinine ratio). The cHIS criteria requires at least two of 6 criteria encompassing fever, macrophage activation, haematological dysfunction, coagulopathy, hepatic injury and cytokinaemia (including CRP concentration). The COV-HI criteria requires either an elevated CRP or ferritin.