Dysregulation of inflammation is hypothesized to play a crucial role in the severe complications of COVID-19, with the IL-1/IL-6 pathway being central. Here, we report on the treatment of eight severe COVID-19 pneumonia patients—seven hospitalized in intensive care units (ICUs) in Greece and one non-ICU patient in the Netherlands—with the interleukin-1 receptor antagonist Anakinra. All patients scored positive for the hemophagocytosis score (HScore) and were diagnosed with secondary hemophagocytic lymphohistocytosis (sHLH) characterized by pancytopenia, hyper-coagulation, acute kidney injury, and hepatobiliary dysfunction. At the end of treatment, ICU patients had less need for vasopressors, significantly improved respiratory function, and lower HScore. Although three patients died, the mortality was lower than historical series of patients with sHLH in sepsis. These data suggest that administration of Anakinra may be beneficial for treating severe COVID-19 patients with sHLH as determined by the HScore, and they support the need for larger clinical studies to validate this concept.

假定炎症的失调在COVID-19的严重并发症中起关键作用，其中IL-1 / IL-6途径是关键。在这里，我们报道了白介素-1受体拮抗剂阿那金拉治疗8例重症COVID-19肺炎患者（其中7例在希腊的重症监护病房（ICU）住院，另外1例在荷兰的非ICU患者）。所有患者的吞噬细胞得分（HScore）均得分阳性，并被诊断为继发性吞噬性淋巴细胞组织细胞增多症（sHLH），其特征为全血细胞减少，高凝，急性肾损伤和肝胆功能障碍。在治疗结束时，ICU患者对血管加压药的需求减少，呼吸功能显着改善，HScore降低。尽管三名患者死亡，败血症中sHLH患者的死亡率低于历史系列。这些数据表明，如HScore所确定的那样，阿那金拉的给药可能对治疗重度sHLH的重症COVID-19患者有益，并且他们支持需要进行大量临床研究以验证这一概念。