Daniel Leisman and colleagues question the role of a cytokine storm in COVID-19-induced organ dysfunction after a systematic review and meta-analysis of 25 COVID-19 studies (n=1245 patients) and four trials each in sepsis (n=5320), cytokine release syndrome (n=72), and acute respiratory distress syndrome unrelated to COVID-19 (n=2767). Mean interleukin-6 concentrations were nearly 100 times higher in patients with cytokine release syndrome (3110.5 pg/mL), 27 times higher in patients with sepsis (983.6 pg/mL), and 12 times higher in patients with acute respiratory distress syndrome unrelated to COVID-19 (460 pg/mL). The authors conclude that alternative mechanisms of COVID-19-induced organ dysfunction are worth considering and that immune-activating treatments (i.e., interferons, IL-7, or checkpoint inhibition) might merit investigation.

Leisman DE, Ronner L, Pinotti R, et al. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Dis 2020, pubished 16 October. Full-text: https://doi.org/10.1016/S2213-2600(20)30404-5

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