RT Journal Article SR Electronic T1 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 JF Clinical Medicine JO Clin Med FD Royal College of Physicians SP e543 OP e547 DO 10.7861/clinmed.2021-0053 VO 21 IS 5 A1 Ardern-Jones, Michael R A1 Stammers, Matt A1 Phan, Hang TT A1 Borca, Florina A1 Koutalopoulou, Anastasia A1 Teo, Ying A1 Batchelor, James A1 Smith, Trevor A1 Duncombe, Andrew S YR 2021 UL http://www.rcpjournals.org/content/21/5/e543.abstract 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.