Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes.

Autor:	Leisman DE; Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA. Electronic address: dleisman@mgh.harvard.edu., Ronner L; Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA., Pinotti R; Levy Library, New York, NY, USA., Taylor MD; Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA; Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA., Sinha P; Department of Anesthesia and Perioperative Care, University of California, San Francisco School of Medicine, San Francisco, CA, USA; Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA., Calfee CS; Department of Anesthesia and Perioperative Care, University of California, San Francisco School of Medicine, San Francisco, CA, USA; Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA; Cardiovascular Research Institute, University of California, San Francisco School of Medicine, San Francisco, CA, USA., Hirayama AV; Clinical Research Division and Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Mastroiani F; Division of Pulmonary and Critical Care Medicine, Northwell Health, NY, USA., Turtle CJ; Clinical Research Division and Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Harhay MO; Department of Biostatistics, Epidemiology, and Informatics and Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Legrand M; Department of Anesthesia and Perioperative Care, University of California, San Francisco School of Medicine, San Francisco, CA, USA., Deutschman CS; Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA; Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA.
Jazyk:	angličtina
Zdroj:	The Lancet. Respiratory medicine [Lancet Respir Med] 2020 Dec; Vol. 8 (12), pp. 1233-1244. Date of Electronic Publication: 2020 Oct 16.
DOI:	10.1016/S2213-2600(20)30404-5
Abstrakt:	The description of a so-called cytokine storm in patients with COVID-19 has prompted consideration of anti-cytokine therapies, particularly interleukin-6 antagonists. However, direct systematic comparisons of COVID-19 with other critical illnesses associated with elevated cytokine concentrations have not been reported. In this Rapid Review, we report the results of a systematic review and meta-analysis of COVID-19 studies published or posted as preprints between Nov 1, 2019, and April 14, 2020, in which interleukin-6 concentrations in patients with severe or critical disease were recorded. 25 COVID-19 studies (n=1245 patients) were ultimately included. Comparator groups included four trials each in sepsis (n=5320), cytokine release syndrome (n=72), and acute respiratory distress syndrome unrelated to COVID-19 (n=2767). In patients with severe or critical COVID-19, the pooled mean serum interleukin-6 concentration was 36·7 pg/mL (95% CI 21·6-62·3 pg/mL; I 2 =57·7%). Mean interleukin-6 concentrations were nearly 100 times higher in patients with cytokine release syndrome (3110·5 pg/mL, 632·3-15 302·9 pg/mL; p<0·0001), 27 times higher in patients with sepsis (983·6 pg/mL, 550·1-1758·4 pg/mL; p<0·0001), and 12 times higher in patients with acute respiratory distress syndrome unrelated to COVID-19 (460 pg/mL, 216·3-978·7 pg/mL; p<0·0001). Our findings question the role of a cytokine storm in COVID-19-induced organ dysfunction. Many questions remain about the immune features of COVID-19 and the potential role of anti-cytokine and immune-modulating treatments in patients with the disease. (Copyright © 2020 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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