PT  - JOURNAL ARTICLE
AU  - Michael R Ardern-Jones
AU  - Matt Stammers
AU  - Hang TT Phan
AU  - Florina Borca
AU  - Anastasia Koutalopoulou
AU  - Ying Teo
AU  - James Batchelor
AU  - Trevor Smith
AU  - Andrew S Duncombe
TI  - Secondary haemophagocytic lymphohistiocytosis in hospitalised COVID-19 patients as indicated by a modified HScore is infrequent and high scores do not associate with increased mortality
AID  - 10.7861/clinmed.2021-0053
DP  - 2021 Aug 13
TA  - Clinical Medicine
PG  - clinmed.2021-0053
4099  - http://www.rcpjournals.org/content/early/2021/08/13/clinmed.2021-0053.short
4100  - http://www.rcpjournals.org/content/early/2021/08/13/clinmed.2021-0053.full
AB  - A significant proportion of COVID-19 patients show evidence of hyperinflammation (HI), of which secondary haemophagocytic lymphohistiocytosis (sHLH) is the most severe manifestation and diagnosed with HScore. Using a COVID-relevant modification of the HScore (%HScore), we set out to determine the prevalence of sHLH in 567 COVID-19 inpatient cases.The overall incidence of individuals with an 80% probability of sHLH in our COVID-19 cohort was 1.59% on admission and only rose to 4.05% if calculated at any time during admission. This small cohort as defined by %HScore showed no excess mortality compared with the whole cohort. Overall, %HScores were lower in older patients (p < 0.0001) and did not reliably predict outcome at any cut-off value (AUROC 0.533, p=0.211, odds ratio 0.99).Our study demonstrates that a modified version (%HScore) of the conventional sHLH scoring system (HScore) does not enable risk stratification in people hospitalised with COVID. We propose further work is needed to develop novel approaches to predict HI and improve trial stratification for HI directed therapy in people with COVID-19.