Approximately 5% of coronavirus disease (COVID-19) patients will require admission to an intensive care unit (ICU). Among these patients, the most severe cases may be mediated by a late-onset systemic inflammatory response with cytokine dysregulation referred to as cytokine release syndrome (CRS).

Clinically, this results in fever, acute respiratory distress syndrome, multiorgan failure, and/or hemodynamic collapse due to distributive shock.

Late-onset severe COVID-19 patients may respond to anti-inflammatory therapy without worsening the initial early viral infection.

We describe a case series of 15 COVID-19 patients admitted to ICU who received corticosteroids in the context of CRS. Cytokine release syndrome was identified as worsening hypoxemia or vasoplegia with rising C-reactive protein (CRP) or interleukin-6 levels without alternative clinical explanation.

The Research Ethics Board at our local site approved this retrospective case series.

Read More