An Update on Pathogenesis, Diagnosis and Treatment of COVID-19-Related Cytokine Storm

Abstract

CoronaVirus Disease 2019 (COVID-19) is a viral infection caused by the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2), which is globally influential and has killed more than 6 million patients until today. Hyper-secretion of pro-inflammatory cytokines triggered by the viral infection that cannot be eliminated by the immune system and an ongoing hyper-inflammatory state primarily in the lung seem to be the major causes of death. The mechanisms proposed to explain the pathogenesis of the cytokine storm associated with COVID-19 included poor viral clearance and persistent robust cytokine response despite inadequate antiviral immunity. The diagnosis can be made easily by clinical features, imaging techniques, and nasopharyngeal PCR. The diagnosis of this hyper-inflammatory state in a patient with COVID-19 can be made with rapid deterioration in clinical features, and laboratory findings including abnormally high serum CRP, ferritin and D-dimer levels, and rapidly progressive pulmonary radiological findings. In addition to the anti-viral and supportive treatments, corticosteroids, IL-1, or IL-6 receptor blockers are frequently used to suppress the increased cytokine response.