Objective: It has been assumed that a significant proportion of COVID-19 patients show evidence of hyperinflammation of which secondary haemophagocytic lymphohistiocytosis (sHLH) is the most severe manifestation. To facilitate diagnosis of sHLH the HScore has been developed and validated. We set out to examine the prevalence of sHLH-like hyperinflammation in COVID-19. Methods: We retrospectively examined HScore parameters in 626 COVID-19 cases admitted to our institute of which 567 were suitable for analysis and compared these to a cohort of confirmed infection associated sHLH cases. To account for missing data, we calculated the maximum possible HScore of the recorded parameters (%HScore). Results: Early measurement of HScore parameters (day -1 to 4 from diagnosis) strongly predicted the %HScore over the course of the admission (p <0.0001). The retrospective cohort of sHLH showed significantly higher %HScores as compared to COVID-19 (median 73.47 vs 18.13 respectively, p <0.0001). The overall prevalence of individuals with an 80% probability of sHLH in our COVID-19 cohort was 1.59% on admission and only rose to 4.05% during the whole disease course. In the small cohort with scores suggestive of sHLH, there was no excess mortality compared with the whole cohort. %HScores were higher in younger patients (p<0.0001) and did not reliably predict outcome at any cut-off value (AUROC 0.533, p=0.211; OR 0.99). Conclusion: Surprisingly, these findings show that sHLH-type hyperinflammation is not prevalent in COVID-19, and %HScores do not predict outcome. Therefore, new algorithms are required to optimise case selection for clinical trials of targeted anti-inflammatory interventions.

中文翻译：

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百分比HScore证实住院的COVID-19患者继发性吞噬淋巴细胞组织细胞增多症的发生率较低

目的：假设有相当一部分COVID-19患者显示出高炎症的证据，其中继发性吞噬性淋巴细胞组织细胞增多症（sHLH）是最严重的表现。为了促进sHLH的诊断，已经开发并验证了HScore。我们着手研究在COVID-19中sHLH样过度炎症的患病率。方法：我们回顾性分析了我院收治的626例COVID-19病例中HScore参数，其中567例适合分析，并将其与确诊的感染相关sHLH病例队列进行了比较。为了解决数据丢失的问题，我们计算了所记录参数的最大可能HScore（％HScore）。结果：早期测量HScore参数（从诊断开始第-1天到第4天）强烈预测了入院过程中的％HScore（p <0.0001）。与COVID-19相比，sHLH的回顾性队列研究显示出％HScore明显更高（中位数分别为73.47和18.13，p <0.0001）。在我们的COVID-19队列中有sHLH可能性为80％的个体的总体患病率是入院时为1.59％，在整个疾病过程中仅上升到4.05％。在提示sHLH的小队列中，与整个队列相比，没有额外的死亡率。在年轻患者中，％HScores较高（p <0.0001），并且在任何临界值（AUROC 0.533，p = 0.211； OR 0.99）下均不能可靠地预测结果。结论：令人惊讶的是，这些发现表明sHLH型过度炎症在COVID-19中并不普遍，并且％HScores不能预测结果。因此，需要新的算法来优化针对靶向抗炎干预措施的临床试验的病例选择。