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Cytokine Storm in Novel Coronavirus Disease (COVID-19): Expert Management Considerations
Yatin Mehta1, Subhal B Dixit2, Kapil G Zirpe3
1Department of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram, Haryana, India.
Insights
Cytokine storm (CRS) is common in severe COVID-19. This review discusses therapeutic options, finding low-dose corticosteroids and heparin beneficial, while more research is needed for other treatments.
Area of Science:
- Critical Care Medicine
- Immunology
- Infectious Diseases
Background:
- Cytokine storm, a hyperinflammatory response involving elevated proinflammatory cytokines, is a critical complication in severe COVID-19.
- This immunopathogenesis can lead to acute lung injury and acute respiratory distress syndrome (ARDS).
- Effective management strategies are crucial for improving outcomes in critically ill COVID-19 patients.
Purpose of the Study:
- To review current therapeutic options for managing cytokine release syndrome (CRS) in COVID-19 patients.
- To identify evidence-based treatments available in India, supported by published guidelines and consensus.
Main Methods:
- Systematic review of published guidelines and consensus recommendations.
- Analysis of existing literature on cytokine storm management in COVID-19.
Main Results:
- Low-dose corticosteroids and heparin demonstrate potential benefits in managing CRS.
- Serine protease inhibitors like ulinastatin are suggested by some experts.
- Evidence for high-dose vitamin C and interleukin-6 inhibitors (e.g., tocilizumab) is limited; Janus kinase inhibitors and Neurokinin-1 receptor antagonists are under research.
- Blood purification and convalescent plasma are potential life-saving options requiring further evidence.
Conclusions:
- Current COVID-19 management is primarily preventive and supportive.
- Various therapies can be employed to manage cytokine storm.
- Further research is essential to substantiate the efficacy of these treatments for CRS in COVID-19.
Aim/Objective/Introduction:
Cytokine storm or cytokine release syndrome (CRS) is inevitable in severe and critically ill patients with novel coronavirus disease-2019 (COVID-19). This review aimed to discuss current therapeutic options for the management of CRS in COVID-19.
Background:
Cytokine storm is caused by the colossal release of proinflammatory cytokines [e.g., IL (interleukin)-2, IL-6, IL-8 TNF (tumor necrosis factor)-α, etc.] causing dysregulated, hyperimmune response. This immunopathogenesis leads to acute lung injury and acute respiratory distress syndrome (ARDS). Targeting cytokine storm with the therapies that are already available in India with the support of published guidelines and consensus can assist in achieving a better outcome in COVID-19.
Review Results:
We predominantly included published guidelines or consensus recommendations about the management of cytokine storm in COVID-19. From the existing literature evidence, it is observed that among the currently available agents, low-dose corticosteroids and heparin can be beneficial in managing cytokine storm. The use of serine protease inhibitors such as ulinastatin has been advised by some experts. Though therapies such as high-dose vitamin C and interleukin-6 inhibitors (e.g., tocilizumab) have been advised, the evidence regarding their use for cytokine storm in COVID-19 is limited. Therapies such as Janus kinase inhibitors (JAK) inhibitors and Neurokinin-1 receptor (NK-1) antagonists are still in research. Besides, pharmaceutical treatments, use of blood purification strategies, and convalescent plasma may be life-saving options in some of the critically ill COVID-19 patients. For these therapies, there is a need to generate further evidence to substantiate their use in CRS management.
Conclusion:
Current management of COVID-19 is preventive and supportive. Different therapies can be used to prevent and treat the cytokine storm. More research is needed for further supporting the use of these treatments in COVID-19.
How To Cite This Article:
Mehta Y, Dixit SB, Zirpe KG, Ansari AS. Cytokine Storm in Novel Coronavirus Disease (COVID-19): Expert Management Considerations. Indian J Crit Care Med 2020;24(6):429-434.
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