Defining the scourge of COVID-19 hyperinflammatory syndrome

Cron, Randy Q; Schulert, Grant S.; Tattersall, Rachel

doi:10.1016/s2665-9913(20)30335-0

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…The hyperinflammation encountered in COVID‐19 is not MAS and is relatively different among other infectious cytokine storm syndromes. There are modest ferritin elevations compared with other cytokine storm syndromes 23,24 . This study has supported this information that patients with MAS complicating sJIA had significantly higher mean ferritin levels than MIS‐C patients (17 863 mg/dL vs 753 mg/dL, P < 0.001).…”

Section: Discussionsupporting

confidence: 75%

“…After the identification of MIS‐C as a cytokine storm, pediatric rheumatologists have been involved in the treatment process because they have experience in the treatment of MAS and frequently use anti‐inflammatory and immunomodulatory therapies. Widespread experience in treating MAS and other cytokine release syndromes suggests the importance of early treatment to avoid life‐threatening complications in MIS‐C patients 24 . In patients with MIS‐C, treatment with IVIG, corticosteroids, and anti‐cytokine therapies should be considered according to the patients’ signs and treatment responses 25 .…”

Section: Discussionmentioning

confidence: 99%

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Comparison of baseline laboratory findings of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis and multisystem inflammatory syndrome in children

et al. 2021

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Aims Recently, multisystem inflammatory syndrome in children (MIS‐C) has been recognized in association with coronavirus disease 2019 as a cytokine storm syndrome. MIS‐C presents with symptoms similar to Kawasaki disease and macrophage activation syndrome (MAS). We aimed to better understand this cytokine storm syndrome by comparing the initial laboratory findings of MIS‐C and MAS. Methods Patients who were diagnosed with MAS due to systemic juvenile idiopathic arthritis in our clinic between March 2002 and November 2020 and with MIS‐C between 20 September and 20 October 2020 were enrolled into the study. The medical files of all patients were reviewed retrospectively. Results A total of 13 MAS (9 boys, 4 girls) and 26 MIS‐C (16 boys,10 girls) patients were included in the study. Hemoglobin, absolute neutrophil and lymphocyte counts, C‐reactive protein (CRP), ferritin, fibrinogen and lactate dehydrogenase (LDH) levels showed significant differences between the two groups (P < 0.05). Patients with MAS had lower hemoglobin (10.10 g/dL) and fibrinogen (2.72 g/dL), but higher ferritin (17 863 mg/dL) and LDH (890.61 U/L) at the time of diagnosis. Patients with MIS‐C had higher absolute neutrophil count (12 180/mm3) and CRP (194.23 mg/dL) values, but lower absolute lymphocyte count (1140/mm3) at the time of diagnosis. Left ventricle ejection fraction was significantly lower in the MIS‐C group in echocardiographic evaluation (P < 0.001). Conclusion Ferritin, hemoglobin, LDH, and fibrinogen levels were significantly changed in MAS compared with MIS‐C. However, patients with MIS‐C have more severe signs than MAS, such as cardiac involvement.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Comparison of baseline laboratory findings of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis and multisystem inflammatory syndrome in children

et al. 2021

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“…In particular, pulmonary micro-thrombosis and disseminated intravascular coagulation are common complications and causes of death [ 35 ]. Among inflammatory biomarkers, CRP, Ferritin, and LDH are some of the main biomarkers responsible for the hyperinflammatory response, which leads to acute respiratory distress syndrome and multiple organ failure [ 36 ]. CRP is an annular (ring-shaped) pentameric protein found in blood plasma whose circulating concentrations rise in response to inflammation.…”

Section: Discussionmentioning

confidence: 99%

Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section

et al. 2022

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Background. COVID-19 is a severe acute respiratory disease caused by SARS-CoV-2, a virus belonging to the Coronaviridae family. This disease has spread rapidly around the world and soon became an international public health emergency leading to an unpredicted pressure on the hospital emergency units. Early routine blood biomarkers could be key predicting factors of COVID-19 morbidity and mortality as suggested for C-reactive protein (CRP), IL-6, prothrombin and D-dimer. This study aims to identify other early routine blood biomarkers for COVID-19 severity prediction disclosed directly into the emergency section. Methods. Our research was conducted on 156 COVID-19 patients hospitalized at the Sapienza University Hospital “Policlinico Umberto I” of Rome, Italy, between March 2020 and April 2020 during the paroxysm’s initial phase of the pandemic. In this retrospective study, patients were divided into three groups according to their outcome: (1) emergency group (patients who entered the emergency room and were discharged shortly after because they did not show severe symptoms); (2) intensive care unit (ICU) group (patients who attended the ICU after admission to the emergency unit); (3) the deceased group (patients with a fatal outcome who attended the emergency and, afterward, the ICU units). Routine laboratory tests from medical records were collected when patients were admitted to the emergency unit. We focused on Aspartate transaminase (AST), Alanine transaminase (ALT), Lactate dehydrogenase (LDH), Creatine kinase (CK), Myoglobin (MGB), Ferritin, CRP, and D-dimer. Results. As expected, ANOVA data show an age morbidity increase in both ICU and deceased groups compared with the emergency group. A main effect of morbidity was revealed by ANOVA for all the analyzed parameters with an elevation between the emergency group and the deceased group. Furthermore, a significant increase in LDH, Ferritin, CRP, and D-dimer was also observed between the ICU group and the emergency group and between the deceased group and ICU group. Receiver operating characteristic (ROC) analyses confirmed and extended these findings. Conclusions. This study suggests that the contemporaneous presence of high levels of LDH, Ferritin, and as expected, CRP, and D-dimer could be considered as potential predictors of COVID-19 severity and death.

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“…Deadly hyperinflammatory responses to diseases like COVID-19 and influenza A result when the immune system overreacts (1)(2)(3)(4)(5)(6). Cytokine storms induced by viral infections trigger this hyperinflammatory state, leading to serious consequences, including acute respiratory distress syndrome (ARDS), pulmonary edema, multiple organ failure, and death.…”

Section: Introductionmentioning

confidence: 99%

Modeling Virus-Induced Inflammation in Zebrafish: A Balance Between Infection Control and Excessive Inflammation

et al. 2021

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The inflammatory response to viral infection in humans is a dynamic process with complex cell interactions that are governed by the immune system and influenced by both host and viral factors. Due to this complexity, the relative contributions of the virus and host factors are best studied in vivo using animal models. In this review, we describe how the zebrafish (Danio rerio) has been used as a powerful model to study host-virus interactions and inflammation by combining robust forward and reverse genetic tools with in vivo imaging of transparent embryos and larvae. The innate immune system has an essential role in the initial inflammatory response to viral infection. Focused studies of the innate immune response to viral infection are possible using the zebrafish model as there is a 4-6 week timeframe during development where they have a functional innate immune system dominated by neutrophils and macrophages. During this timeframe, zebrafish lack a functional adaptive immune system, so it is possible to study the innate immune response in isolation. Sequencing of the zebrafish genome has revealed significant genetic conservation with the human genome, and multiple studies have revealed both functional conservation of genes, including those critical to host cell infection and host cell inflammatory response. In addition to studying several fish viruses, zebrafish infection models have been developed for several human viruses, including influenza A, noroviruses, chikungunya, Zika, dengue, herpes simplex virus type 1, Sindbis, and hepatitis C virus. The development of these diverse viral infection models, coupled with the inherent strengths of the zebrafish model, particularly as it relates to our understanding of macrophage and neutrophil biology, offers opportunities for far more intensive studies aimed at understanding conserved host responses to viral infection. In this context, we review aspects relating to the evolution of innate immunity, including the evolution of viral pattern recognition receptors, interferons and interferon receptors, and non-coding RNAs.

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Defining the scourge of COVID-19 hyperinflammatory syndrome

Cited by 8 publications

References 10 publications

Comparison of baseline laboratory findings of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis and multisystem inflammatory syndrome in children

Comparison of baseline laboratory findings of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis and multisystem inflammatory syndrome in children

Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section

Modeling Virus-Induced Inflammation in Zebrafish: A Balance Between Infection Control and Excessive Inflammation

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