• Michael R Ardern-Jones, Matt Stammers, Hang Tt Phan, Florina Borca, Anastasia Koutalopoulou, Ying Teo, James Batchelor, Trevor Smith, and Andrew S Duncombe.
• University of Southampton, Southampton UK, and consultant dermatologist, University Hospital Southampton NHS Foundation Trust, Southampton, UK m.aj@soton.ac.uk.
• Clin Med (Lond). 2021 Sep 1; 21 (5): e543e547e543-e547.

AbstractA 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.© Royal College of Physicians 2021. All rights reserved.

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