ABSTRACT

Introduction

Coronavirus disease (COVID-19) can trigger a cytokine response storm (CRS) that is associated with high mortality but for which the underlying pathophysiology and diagnostics are not yet well characterized. This review provides an overview of the underlying immune profile of COVID-19-related CRS as well as laboratory markers for acute diagnosis and chronic follow-up of patients with SARS-CoV-2 and CRS.

Areas covered

Innate and acquired immune profiles in COVID-19-CRS, RNA-detection methods for SARS-CoV-2 in the setting of CRS including factors that affect assay performance, serology for SARS-CoV-2 in the setting of CRS, and other biomarkers for COVID-19 will be discussed.

Expert opinion

Studies support the implication of CRS in the pathogenesis, clinical severity and outcome of COVID-19 through the production of multiple inflammatory cytokines and chemokines from activated innate and adaptive immune cells. Although these inflammatory molecules, including IL-6, IL-2 R, IL-10, IP-10 and MCP-1, often correlate with disease severity as possible biomarkers, the pathogenic contributions of individual molecules and the therapeutic benefits of targeting them are yet to be demonstrated. Detection of SARS-CoV-2 RNA is the gold standard method for diagnosis of COVID-19 in the context of CRS but assay performance varies and is susceptible to false-negative results even as patients clinically deteriorate due to decreased viral shedding in the setting of CRS. Biomarkers including CRP, ferritin, D-dimer and procalcitonin may provide early clues about progression to CRS and help identify thrombotic and infectious complications of COVID-19.

中文翻译：

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在细胞因子释放综合征中诊断SARS-CoV-2感染

摘要

介绍

冠状病毒疾病（COVID-19）可以引发与高死亡率相关的细胞因子反应风暴（CRS），但对其潜在的病理生理学和诊断尚不十分清楚。这篇综述概述了与COVID-19相关的CRS的潜在免疫谱，以及SARS-CoV-2和CRS患者的急性诊断和慢性随访的实验室标记。

覆盖区域

COVID-19-CRS的先天和后天免疫特征，CRS情况下SARS-CoV-2的RNA检测方法，包括影响测定性能的因素，CRS情况下SARS-CoV-2的血清学以及其他生物标记物将讨论COVID-19。

专家意见

研究通过激活的先天性和适应性免疫细胞产生多种炎性细胞因子和趋化因子，支持CRS在COVID-19的发病机理，临床严重性和结果中的意义。尽管这些炎性分子（包括IL-6，IL-2 R，IL-10，IP-10和MCP-1）通常与疾病的严重程度相关，可能是生物标志物，但单个分子的致病作用和靶向它们的治疗益处却是有待证明。SARS-CoV-2 RNA的检测是在CRS情况下诊断COVID-19的金标准方法，但是即使患者由于在环境中病毒脱落减少而临床恶化，其检测性能也会变化并且容易出现假阴性结果。 CRS。生物标志物包括CRP，铁蛋白，