Mehta Yatin, Dixit Subhal B, Zirpe Kapil G, Ansari Abdul S
Department of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram, Haryana, India.
Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India.
Indian J Crit Care Med. 2020 Jun;24(6):429-434. doi: 10.5005/jp-journals-10071-23415.
AIM/OBJECTIVE/INTRODUCTION: Cytokine storm or cytokine release syndrome (CRS) is inevitable in severe and critically ill patients with novel coronavirus disease-2019 (COVID-19). This review aimed to discuss current therapeutic options for the management of CRS in COVID-19.
Cytokine storm is caused by the colossal release of proinflammatory cytokines [e.g., IL (interleukin)-2, IL-6, IL-8 TNF (tumor necrosis factor)-α, etc.] causing dysregulated, hyperimmune response. This immunopathogenesis leads to acute lung injury and acute respiratory distress syndrome (ARDS). Targeting cytokine storm with the therapies that are already available in India with the support of published guidelines and consensus can assist in achieving a better outcome in COVID-19.
We predominantly included published guidelines or consensus recommendations about the management of cytokine storm in COVID-19. From the existing literature evidence, it is observed that among the currently available agents, low-dose corticosteroids and heparin can be beneficial in managing cytokine storm. The use of serine protease inhibitors such as ulinastatin has been advised by some experts. Though therapies such as high-dose vitamin C and interleukin-6 inhibitors (e.g., tocilizumab) have been advised, the evidence regarding their use for cytokine storm in COVID-19 is limited. Therapies such as Janus kinase inhibitors (JAK) inhibitors and Neurokinin-1 receptor (NK-1) antagonists are still in research. Besides, pharmaceutical treatments, use of blood purification strategies, and convalescent plasma may be life-saving options in some of the critically ill COVID-19 patients. For these therapies, there is a need to generate further evidence to substantiate their use in CRS management.
Current management of COVID-19 is preventive and supportive. Different therapies can be used to prevent and treat the cytokine storm. More research is needed for further supporting the use of these treatments in COVID-19.
Mehta Y, Dixit SB, Zirpe KG, Ansari AS. Cytokine Storm in Novel Coronavirus Disease (COVID-19): Expert Management Considerations. Indian J Crit Care Med 2020;24(6):429-434.
目的/目标/引言：细胞因子风暴或细胞因子释放综合征（CRS）在新型冠状病毒肺炎（COVID-19）的重症和危重症患者中不可避免。本综述旨在探讨目前用于治疗COVID-19中CRS的治疗选择。
细胞因子风暴是由促炎细胞因子[如白细胞介素（IL）-2、IL-6、IL-8、肿瘤坏死因子（TNF）-α等]的大量释放引起的，导致免疫反应失调和过度免疫反应。这种免疫发病机制会导致急性肺损伤和急性呼吸窘迫综合征（ARDS）。在已发表的指南和共识的支持下，使用印度现有的治疗方法来靶向细胞因子风暴有助于在COVID-19中取得更好的治疗效果。
我们主要纳入了已发表的关于COVID-19中细胞因子风暴管理的指南或共识建议。从现有文献证据来看，在目前可用的药物中，低剂量皮质类固醇和肝素可能有助于控制细胞因子风暴。一些专家建议使用丝氨酸蛋白酶抑制剂，如乌司他丁。尽管有人建议使用高剂量维生素C和白细胞介素-6抑制剂（如托珠单抗），但关于它们在COVID-19中用于治疗细胞因子风暴的证据有限。Janus激酶抑制剂（JAK）和神经激肽-1受体（NK-1）拮抗剂等治疗方法仍在研究中。此外，在一些COVID-19危重症患者中，药物治疗、血液净化策略和康复期血浆可能是挽救生命的选择。对于这些治疗方法，需要进一步的证据来证实它们在CRS管理中的应用。
目前对COVID-19的治疗是预防性和支持性的。可以使用不同的治疗方法来预防和治疗细胞因子风暴。需要更多的研究来进一步支持这些治疗方法在COVID-19中的应用。
Mehta Y, Dixit SB, Zirpe KG, Ansari AS. 新型冠状病毒病（COVID-19）中的细胞因子风暴：专家管理考量。《印度重症监护医学杂志》2020；24(6):429 - 434。
