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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

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
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
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 H score 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; OR 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 recruitment for HI directed therapy in people with COVID-19.
Aged, COVID-19, Cohort Studies, Humans, Incidence, Lymphohistiocytosis, Hemophagocytic/epidemiology, SARS-CoV-2
1470-2118
e543-e547
Ardern-Jones, Michael R
7ac43c24-94ab-4d19-ba69-afaa546bec90
Stammers, Matt
85e202da-1879-4f96-8e24-5059a1fa3f1e
Phan, Hang Tt
2811b94c-62b7-459d-9cc1-c88057008e3b
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Koutalopoulou, Anastasia
f3d3331a-a066-49a2-8fd2-ea8c6fcb9f4d
Teo, Ying
f3243472-0f73-4bdc-ad4f-2f67247e21c4
Batchelor, James
e53c36c7-aa7f-4fae-8113-30bfbb9b36ee
Smith, Trevor
53e6838c-2e95-4c8f-9325-53163ab6255d
Duncombe, Andrew S
ce7cb7e9-5aec-4801-ab3c-18b4de474fef
Ardern-Jones, Michael R
7ac43c24-94ab-4d19-ba69-afaa546bec90
Stammers, Matt
85e202da-1879-4f96-8e24-5059a1fa3f1e
Phan, Hang Tt
2811b94c-62b7-459d-9cc1-c88057008e3b
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Koutalopoulou, Anastasia
f3d3331a-a066-49a2-8fd2-ea8c6fcb9f4d
Teo, Ying
f3243472-0f73-4bdc-ad4f-2f67247e21c4
Batchelor, James
e53c36c7-aa7f-4fae-8113-30bfbb9b36ee
Smith, Trevor
53e6838c-2e95-4c8f-9325-53163ab6255d
Duncombe, Andrew S
ce7cb7e9-5aec-4801-ab3c-18b4de474fef

Ardern-Jones, Michael R, Stammers, Matt, Phan, Hang Tt, Borca, Florina, Koutalopoulou, Anastasia, Teo, Ying, Batchelor, James, Smith, Trevor and Duncombe, Andrew S (2021) 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. Clinical Medicine, 21 (5), e543-e547. (doi:10.7861/clinmed.2021-0053).

Record type: Article

Abstract

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 H score 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; OR 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 recruitment for HI directed therapy in people with COVID-19.

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Accepted/In Press date: 4 June 2021
Published date: 10 September 2021
Keywords: Aged, COVID-19, Cohort Studies, Humans, Incidence, Lymphohistiocytosis, Hemophagocytic/epidemiology, SARS-CoV-2

Identifiers

Local EPrints ID: 449727
URI: http://eprints.soton.ac.uk/id/eprint/449727
ISSN: 1470-2118
PURE UUID: 22fe0fd4-cedf-4c4d-a74b-a8f1407f92b2
ORCID for James Batchelor: ORCID iD orcid.org/0000-0002-5307-552X

Catalogue record

Date deposited: 14 Jun 2021 16:31
Last modified: 22 Nov 2021 02:41

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Contributors

Author: Matt Stammers
Author: Hang Tt Phan
Author: Florina Borca
Author: Anastasia Koutalopoulou
Author: Ying Teo
Author: James Batchelor ORCID iD
Author: Trevor Smith
Author: Andrew S Duncombe

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