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.