Corticosteroids for critically ill COVID-19 patients with cytokine release syndrome: a limited case series
Abstract
To the Editor, Approximately 5% of coronavirus disease (COVID-19) patients will require admission to an intensive care unit (ICU). Among these patients, the most severe cases may be mediated by a late-onset systemic inflammatory response with cytokine dysregulation referred to as cytokine release syndrome (CRS). Clinically, this results in fever, acute respiratory distress syndrome, multiorgan failure, and/or hemodynamic collapse due to distributive shock. Late-onset severe COVID-19 patients may respond to anti-inflammatory therapy without worsening the initial early viral infection. We describe a case series of 15 COVID-19 patients admitted to ICU who received corticosteroids in the context of CRS. Cytokine release syndrome was identified as worsening hypoxemia or vasoplegia with rising C-reactive protein (CRP) or interleukin-6 levels without alternative clinical explanation. The Research Ethics Board at our local site approved this retrospective case series. The characteristics of these patients are provided in the Table. The median [interquartile range (IQR)] age was 72 [62-74] yr (range, 45-75 yr), and nine of the 15 patients (60%) were male. The indications for steroid administration were hypoxic respiratory failure (67%), vasoplegic shock on multiple vasopressors (20%), or both respiratory and cardiovascular failure (20%). Two nonintubated patients received steroids for impending respiratory failure with increasing inflammatory markers concerning for CRS. The median…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 19 participants or records.
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