2.3 Septic shock
According to the last International Consensus Definitions for Sepsis and Septic Shock, sepsis is defined as a life-threatening organ dysfunction, that can be represented by an increase in the Sequential Sepsis-related Organ Failure Assessment score of 2 points or more, caused by a dysregulated host response to infection (59). Sepsis can be a life-threatening condition and sometimes can have features in common with HLH, such as hyperferritinemia. Nevertheless, as reported by the 2019 guideline of HLH, forms of sepsis characterized by a marked inflammation, but less than a proper form of HLH, may not fulfil the diagnostic criteria of HLH and are described as “MAS-like”. For this reason, in critically ill patients with confirmed or presumed case of sepsis, it is important to exclude the diagnose of HLH (60). It is important to underline that viremia, as it has been demonstrated for DNAemia due to Herpes simplex type 1, human herpesvirus 6, Epstein-Barr virus, cytomegalovirus, and adenovirus, was associated with hyperferritinemia and adverse outcome in paediatric severe sepsis (61). Whether there is a correlation between SARS-CoV-2 replication and ferritinemia would be of great interest.