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

  1. Michael R Ardern-Jones
  2. Matt Stammers
  3. Hang TT Phan
  4. Florina Borca
  5. Anastasia Koutalopoulou
  6. Ying Teo
  7. James Batchelor
  8. Trevor Smith
  9. Andrew S Duncombe

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Abstract

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  1. Version published to 10.7861/clinmed.2021-0053
  2. ScreenIT

    SciScore for 10.1101/2020.10.19.20214015: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Structured and semi-structured data was accrued from the trust integration engine using SQL Developer 4.2 queries and then cleaned/transformed using python 3.7 and associated libraries: numpy and pandas.
    python
    suggested: (IPython, RRID:SCR_001658)
    numpy
    suggested: (NumPy, RRID:SCR_008633)
    Analysis was performed using matplotlib, seaborn and scipy.
    matplotlib
    suggested: (MatPlotLib, RRID:SCR_008624)
    scipy
    suggested: (SciPy, RRID:SCR_008058)
    Statistical analysis was undertaken using GraphPad, Prism (8.4.3).
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Prism
    suggested: (PRISM, RRID:SCR_005375)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The limitations of this work include the retrospective design and heterogeneity across the cohort of the recorded number of HScore parameters for assessment. However, the design allowed us to recruit all cases of viral RNA confirmed COVID-19 cases and we report here one of the largest datasets of COVID-19 to date which exceeds the 312 sHLH cases in the original series identifying the HScore (7) and the 40 cases where HScore was applied to intensive care patients (11). To address missing data, we utilised a mathematical programmed approach to facilitate rigorous data collection from centralised hospital electronic records and utilised cross-checking and cross-validation to optimise data cleaning, thus avoiding collection errors, while minimising missing data. Furthermore, to identify the subgroup with sHLH in COVID-19 we undertook a stringent approach to the analysis and did not impute any missing values and instead designed a modified HScore, %Hscore. In this report, we demonstrate that sHLH is rare in hospitalised cases of COVID-19 similar to the reports of low incidence in intensive care settings (9, 11). Indeed, we estimate that sHLH arises in 1.59% of hospitalised COVID-19 cases early in the course of the illness, and only rising to 4.7% over the whole admission. Surprisingly, mortality in the cohort of COVID-19 cases meeting 80% probability of sHLH showed no excess mortality as compared to the whole cohort (30.43% vs 30.69%). It is notable that the index cohort of sHLH c...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.10.19.20214015v1 on medRxiv