Cytokine Storm May Be the Cause of Death in COVID-19

Douglas K. Rex, MD, FASGE, reviewing Mehta P, et al. Lancet 2020 Mar 16.

In a letter to the Lancet, authors argued that secondary hemophagocytic lymphohistiocytosis (sHLH), a hyperinflammatory syndrome characterized by fulminant hypercytokinemia and multiple organ failure, is part of florid COVID-19 infection. sHLH is associated with viral syndromes and sepsis and is characterized by fever, markedly elevated ferritin levels, and cytopenias. Pulmonary manifestations, including acute respiratory distress syndrome, are common. Severe COVID-19 shares some of the same clinical features and cytokine profile as sHLH. The authors show a scoring system (HScore) that can be used to calculate the likelihood of sHLH. The authors suggest that all patients with severe COVID-19 infection should be tested for hyperinflammation, using laboratory values, and have HScores calculated to identify patients who might benefit from immunosuppression, perhaps with cytokine inhibitors (eg, anakinra, tocilizumab) or Janus kinase inhibitors.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, FASGE

CITATION(S)

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH Across Specialty Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020 Mar 16. (Epub ahead of print) (https://doi.org/10.1016/S0140-6736(20)30628-0)