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Cytokine Storm: A Significant Cause of Mortality in COVID-19
April 19,2022 (Edit) Wondfo

Hyper-inflammatory responses in various diseases often lead to life-threatening complications and increased mortality. However, for a long time, medical experts have used various terms to describe this condition. The term cytokine storm was coined roughly 25 years ago; nonetheless the disease has regained researchers’ attention during the COVID-19 pandemic.

In this article, we will discuss the cytokine storm disease, its causes, and symptoms. Furthermore, we will analyze such a condition and its relation with COVID-19 infection.

Cytokine storm

Cytokine storm is a type of system inflammatory response syndrome (SIRS). The disease mechanism is demonstrated through the excessive activation of immune cells. The interleukins, TNF-a, and complement protein molecules in the intracellular inflammatory factors are released in large quantities, which carry out destructive attacks on the source of infection and the infected cells. The worst result is multiple organ failure (MOF).
Inflammation is a protective immune response that helps to clear the source of infection. However, uncontrollable excessive inflammation can bring about "autoimmune damage," an excessive protective response.
In the intensive care unit (ICU), "Inflammatory Cytokine storms" are among the main causes of high mortality in patients with sepsis.
The dysregulation of immune response can be triggered by genetic abnormality, pathogen intrusion and influence of drug.

Cytokine storm under COVID-19 infection

Decreased lymphocytes is commonly detected in patients infected with COVID-19, and dramatic rise of IL-6 can be observed in some cases. In COVID-19, the cytokine storm seems to start with an increased response of cytokines like TNF and IL-1β and IL-8, along with MCP-1. However, these are just part of the early cytokine response. The rise in these cytokines causes a sustained and prolonged increase in the levels of IL-6. The persistent existence of IL-6 makes it easier to be detected in blood sample of patients who goes to the hospital after the symptom onset.
Ultimately, IL-6 and other pleiotropic cytokines drive the acute phase of cytokine storm in COVID-19. Such a response leads to the elevation of various inflammatory markers like CRP, ferritin, and pro-coagulant factors. Most of these factors are readily measurable by diagnostic tests.
Cytokines of increasing concentration (e.g., IL-6) can reduce the lymphocyte count, thus compromising the immune response to the pathogen. Destruction of lymphocytes particularly reduces the ability to fight COVID-19 infection. Cytokine becomes even more dysregulated. It initially causes greater lung damage. Soon, this immune dysregulation spread, affecting other organs like kidney, heart, blood vessels, and even brain.

Cytokine Storm in Clinical Cases

Regretfully, there is no globally accepted protocol for identifying cytokine storms in their early stages. Fortunately, its risk and severity can be assessed with many commonly available laboratory tests for various inflammatory markers.
Studies show that IL-6, IL-8, and TNF are independent predictors of cytokine storm and related mortality. It means that their levels can predict the independence of other factors like vitals, hypoxia, demographics, inflammatory markers. Studies also show that IL-6 is the most accurate (highest specificity and sensitivity) and independent biomarker among these markers. For managing COVID-19 patients, IL-6 can be used to predict the outcomes and decide therapeutic approaches.
Along with these cytokines, inflammatory markers like CRP and coagulopathy markers like D-dimer, which is also one of the excellent predictors of severity of the condition and disease outcomes. 

Finecare™ FIA Meter II Plus SE

Finecare analyzer is excellent for understanding the immune response to COVID-19, helping provide antibody levels, IgM/IgG ratio. It may be particularly useful for understanding the severity of cytokine storms as it helps assess the levels of IL-6, one of the most vital in an acute cytokine storm. 
With the equipment is also possible to use other non-specific inflammatory markers like CRP to understand the condition's severity further. Finecare FIA Meter II Plus SE can also provide levels of D-dimer, the most vital marker for coagulopathy and outcomes in hospitalized COVID-19 patients.
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