COVID-19: consider cytokine storm syndromes and immunosuppression

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression

“…[47] Thus, this condition may further exaggerate the cytokine storms in COVID-19 leading to a more severe disease. [37,48,49]…”

Nervous system involvement after infection with COVID-19 and other coronaviruses

“…Data from the use of experimental mouse models suggests that influenza virus can aggravate ischemic brain injury by triggering a cytokine cascade and increase the risk of cerebral hemorrhage after treatment with tissue-type plasminogen activator (Muhammad et al, 2011). The infection of CoV, especially SARS-CoV-2, has been widely reported to cause cytokine storm syndromes, which may be one of the factors that CoV cause acute cerebrobasilar disease (Mehta et al, 2020;Chen et al, 2020). In addition, critically ill patients with severe SARS-CoV-2 infections often show elevated levels of D-dimer and severe platelet reduction, which may render these patients prone to acute cerebrovascular events .…”

“…The pathology of severe viral infections is closely linked to the development of a systemic inflammatory response syndrome (SIRS). SIRS could be abnormally initiated in severe pneumonia caused by CoV infection, while early antiinflammatory intervention effectively prevent immune damage and reduce the risk of injury in the nervous system (Mehta et al, 2020;Fu et al, 2020). Furthermore, SARS and COVID-19 have resulted in a large number of fatalities, most of which have been due to multiple organs failure (MOF) caused by virus-induced SIRS or SIRS-like immune disorders (Yin et al, 2004;Chen et al, 2020).…”

COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal

“…A form akin to hemophagocytic lymphohistiocytosis (sHLH) may occur in patients in this advanced stage of disease. 11 In this stage, shock, vasoplegia, respiratory failure and even cardiopulmonary collapse are discernable. Systemic organ involvement, even myocarditis, would manifest during this stage.…”

“…In this phase, use of corticosteroids may be justified in concert with the use of cytokine inhibitors such as tocilizumab (IL-6 inhibitor) or anakinra (IL-1 receptor antagonist). 11 Intravenous immune globulin (IVIG) may also play a role in modulating an immune system that is in a hyperinflammatory state. Overall, the prognosis and recovery from this critical stage of illness is poor, and rapid recognition and deployment of such therapy may have the greatest yield.…”