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Coronavirus (COVID-19)

Cytokine Levels in Critically Ill Patients With COVID-19 and Other Conditions

Educational Objective
To understand how cytokine levels in critically ill patients with COVID-19 can help us manage the pandemic

1 Credit CME

JAMA

Published Online: September 3, 2020

Research Letter

Article Information and Disclosures

Matthijs Kox, PhD¹;

Nicole J. B. Waalders, BSc¹;

Emma J. Kooistra, BSc¹;

Jelle Gerretsen, BSc¹;

Peter Pickkers, MD, PhD¹

Author Affiliations

¹Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands

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An abnormally strong proinflammatory response known as “cytokine storm” may play an important role in the pathophysiology of coronavirus disease 2019 (COVID-19), although cytokine storm remains ill defined.¹ Sinha and colleagues² reported that although IL-6 levels are elevated in severe COVID-19, they are lower than levels usually observed in (non–COVID-19) acute respiratory distress syndrome (ARDS). However, this comparison is limited by the use of different assays, which are not well standardized.³ We compared cytokine levels in critically ill patients with COVID-19 vs levels in patients with other critical illnesses.

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Article Information

Corresponding Author: Peter Pickkers, MD, PhD, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, the Netherlands (peter.pickkers@radboudumc.nl).

Accepted for Publication: August 20, 2020.

Published Online: September 3, 2020. doi:10.1001/jama.2020.17052

Author Contributions: Dr Kox had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kox, Pickkers.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Kox, Waalders, Pickkers.

Critical revision of the manuscript for important intellectual content: Kooistra, Gerretsen, Pickkers.

Statistical analysis: Kox, Waalders.

Administrative, technical, or material support: Waalders, Kooistra, Pickkers.

Supervision: Pickkers.

Conflict of Interest Disclosures: None reported.

References

Tisoncik JR , Korth MJ , Simmons CP , Farrar J , Martin TR , Katze MG . Into the eye of the cytokine storm. Microbiol Mol Biol Rev. 2012;76(1):16-32. doi:10.1128/MMBR.05015-11 PubMed Google Scholar Crossref

Sinha P , Matthay MA , Calfee CS . Is a “cytokine storm” relevant to COVID-19? JAMA Intern Med. Published online June 30, 2020. doi:10.1001/jamainternmed.2020.3313 PubMed Google Scholar

Khan SS , Smith MS , Reda D , Suffredini AF , McCoy JP Jr . Multiplex bead array assays for detection of soluble cytokines: comparisons of sensitivity and quantitative values among kits from multiple manufacturers. Cytometry B Clin Cytom. 2004;61(1):35-39. doi:10.1002/cyto.b.20021 PubMed Google Scholar Crossref

Habes QLM , van Ede L , Gerretsen J , Kox M , Pickkers P . Norepinephrine contributes to enterocyte damage in septic shock patients: a prospective cohort study. Shock. 2018;49(2):137-143. doi:10.1097/SHK.0000000000000955 PubMed Google Scholar Crossref

Timmermans K , Kox M , Vaneker M , et al. Plasma levels of danger-associated molecular patterns are associated with immune suppression in trauma patients. Intensive Care Med. 2016;42(4):551-561. doi:10.1007/s00134-015-4205-3 PubMed Google Scholar Crossref

Timmermans K , Kox M , Gerretsen J , et al. The involvement of danger-associated molecular patterns in the development of immunoparalysis in cardiac arrest patients. Crit Care Med. 2015;43(11):2332-2338. doi:10.1097/CCM.0000000000001204 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.