ABSTRACT

Introduction: The mortality of coronavirus disease 2019 (COVID-19) is frequently driven by an injurious immune response characterized by the development of acute respiratory distress syndrome (ARDS), endotheliitis, coagulopathy, and multi-organ failure. This spectrum of hyperinflammation in COVID-19 is commonly referred to as cytokine storm syndrome (CSS).

Areas covered: Medline and Google Scholar were searched up until 15th of August 2020 for relevant literature. Evidence supports a role of dysregulated immune responses in the immunopathogenesis of severe COVID-19. CSS associated with SARS-CoV-2 shows similarities to the exuberant cytokine production in some patients with viral infection (e.g.SARS-CoV-1) and may be confused with other syndromes of hyperinflammation like the cytokine release syndrome (CRS) in CAR-T cell therapy. Interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha have emerged as predictors of COVID-19 severity and in-hospital mortality.

Expert opinion: Despite similarities, COVID-19-CSS appears to be distinct from HLH, MAS, and CRS, and the application of HLH diagnostic scores and criteria to COVID-19 is not supported by emerging data. While immunosuppressive therapy with glucocorticoids has shown a mortality benefit, cytokine inhibitors may hold promise as ‘rescue therapies’ in severe COVID-19. Given the arguably limited benefit in advanced disease, strategies to prevent the development of COVID-19-CSS are needed.

摘要

简介：2019 年冠状病毒病 (COVID-19) 的死亡率通常是由有害的免疫反应驱动的，其特征是出现急性呼吸窘迫综合征 (ARDS)、内皮炎、凝血病和多器官衰竭。COVID-19 中的这种过度炎症通常称为细胞因子风暴综合征 (CSS)。

涵盖领域：截至 2020 年 8 月 15 日，在 Medline 和 Google Scholar 上检索相关文献。有证据支持免疫反应失调在重症 COVID-19 免疫发病机制中的作用。与 SARS-CoV-2 相关的 CSS 与某些病毒感染患者（例如 SARS-CoV-1）中细胞因子产生旺盛相似，并且可能与其他过度炎症综合征相混淆，例如 CAR-T 细胞中的细胞因子释放综合征 (CRS)治疗。白细胞介素 (IL)-6、IL-8 和肿瘤坏死因子-α 已成为 COVID-19 严重程度和院内死亡率的预测因子。

专家意见：尽管有相似之处，但 COVID-19-CSS 似乎与 HLH、MAS 和 CRS 不同，并且新兴数据不支持将 HLH 诊断评分和标准应用于 COVID-19。虽然糖皮质激素的免疫抑制治疗已显示出可降低死亡率，但细胞因子抑制剂可能有望成为严重 COVID-19 的“救援疗法”。鉴于对晚期疾病的益处可能有限，因此需要制定预防 COVID-19-CSS 发展的策略。