Background/Purpose: COVID-19, the name given to the clinical syndrome associated with the newly recognized virus SARS-CoV-2 has become pandemic with mortality estimated based on reports from China between 1-3% and complications among hospitalized patients leading to up to 15-25% admissions to the  ICU. The clinical presentation includes both upper and lower respiratory tract infection, but patients may also be asymptomatic.   The term “cytokine storm” calls up vivid images of an immune system gone awry and an inflammatory response flaring out of control. The term has captured the attention of the public and the scientific community alike and is increasingly being used in both the popular media and the scientific literature. Indeed, a few publications have indicated an important part of the complications in COVID19 are related to a cytokine storm.

Methods: Over 100 patients were hospitalized at Hadassah-Hebrew University Hospital, Jerusalem, in the recent 3 months with the diagnosis of COVID19. We  summarized the clinical outcomes and their correlation (using NEWS2) to a cytokine storm at Hadassah. 30 different cytokines/chemokines/ hematopoietic growth factors were analyzed and compared to clinical manifestations. Serum cytokine/chemokine measurement was performed using the Luminex MAGPIX system (Luminex Corp, Texas, USA) and analyzed with Milliplex analysis software (Millipore MA, USA). The following cytokine/ chemokines were measured by sandwich ELISA kits: IL-18 (R&D), MCP-3 (R&D), TNFR1 (R&D), TREM-1 (R&D), procalcitonin (PCT) (IBL-America, MN, USA).

Results: We were able identify a correlation between disease severity (NEWS2),  and  16  immunological biomarkers including IL6, TNF-alpha, IL18, IFN-a, IFN-b, IFN-g,  IL-2R, IL-8, IL-10, TNF-R1, IL-1Ra, MCP-1, MIP-1 alpha, IP-10, IL8 and GM-CSF that have been associated with disease severity. IL-1 was not markedly elevated. The NEWS2 severity was strongly supported by a correlation to CRP, ferritin, d-dimer, and lymphopenia. 

Conclusion: In this cohort of patients with COVID19, cytokine storm surprisingly did not include IL-1b and is typically characterized by both pro-inflammatory and anti-inflammatory cytokines/ chemokines / hematopoeitic growth factors. Typ1 1 IFN were not decreased upon development of the storm.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/characterizations-of-cytokine-storm-associated-with-covid19/