Background: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. Methods: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. Results: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients ( p = 0.043), RR = 2.1 (95% CI 1.0–4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients ( p = 0.013), RR = 0.50 (95% CI 0.25–0.99). Conclusions: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality.
【저자키워드】 Inflammation, ARDS, Cytokine storm syndrome, monoclonal antibodies, 【초록키워드】 COVID-19, Treatment, Macrophage, Cytokine storm, therapy, Mortality, Tocilizumab, Pneumonia, interleukin-6, C-reactive protein, D-dimer, ferritin, Sepsis, cytokine, Cytokine storm syndrome, Cytokine release syndrome, Retrospective study, interleukin, Patient, fibrinogen, macrophage activation syndrome, mortality rate, SARS-CoV-2 pneumonia, patients, calcitonin, CRS, Pancytopenia, Diagnostic Criteria, Serum ferritin, treatment results, 95% CI, three groups, increased mortality, tocilizumab therapy, heterogenous, Hypofibrinogenemia, subtype, tested, was used, examined, the patient, diagnosed, reduced, significantly higher, contributed, groups, three group, patients with COVID-19, patients with SARS-CoV-2, were assessed, 【제목키워드】 COVID-19, storm, subtype,