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Objective: Coronavirus disease-2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome-coronavirus-2 continues across the world. Some patients with COVID-19 develop cytokine storm secondary to virally driven hyper-inflammation. This study aimed to assess the relationship of interleukin-6 (IL-6), procalsitonin (PCT) and C-reactive protein (CRP) levels with the severity of the disease in patients with COVID-19. Materials and Methods: This retrospective study included 63 patients diagnosed with COVID-19 from January 2020 to March 2021. Data on demographic characteristics and clinical characteristics with the levels of IL-6, CRP, and PCT on admission were collected. ROC analysis was performed to determine whether interleukin-6 had a diagnostic value in predicting mortality. IL-6, CRP and procalcitonin values were evaluated by the Spearman correlation analysis. Results: In the ROC analysis performed in terms of predicting mortality, it was observed that IL-6 level predicted mortality at a statistically significant level (area under the curve: 0.708, p=0.004, 95% confidence interval: 0.583-0.833). A value of >358.3 pg/mL for IL-6 showed prognostic significance on mortality. In the Spearman correlation analysis performed between IL-6, CRP and procalcitonin values, a positive correlation was observed between CRP and procalcitonin (r=0.474, p=0.001). Conclusion: The serum levels of IL-6 and CRP can effectively assess disease severity in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Objective: Immunosuppressive drugs are included in the treatment protocols of severe COVID-19 cases that may present with cytokine storm. In this study, we aimed to examine the characteristics of COVID-19 patients who received immunosuppressive therapy Methods: Patients diagnosed with COVID-19 and followed in the quarantine wards of our hospital between 01.03.2020-24.05.2020 were included in the study. Patient information was obtained retrospectively from patient files and discharge reports, and 263 COVID-19 patients -aged 18 and over- were included in the study. Results: The median age of the patients who received immunosuppressive therapy was 60.74 ± 1.96, and 39.6% of them were women. The average symptom duration of the patients examined in the study at the time of admission to the hospital was 4.59 ± 0.29 days. There was a significant difference in age, lymphocyte count, neutrophil/lymphocyte ratio, C-reactive protein, ferritin, D-Dimer, blood oxygen saturation, fever after antiviral therapy, qSOFA score, and total hospital stay between the two groups that received and did not receive immunosuppressive therapy (p<0.05). The need for immunosuppressive therapy increased 15.9 times over the age of 40, 15.6 times in the presence of diffuse involvement on thoracic CT, 6.6 times in the presence of chronic disease, 2.7 times in the presence of thrombocytopenia, and 1.7 times in the presence of lymphopenia (p <0.05). Conclusions: We observed that patients whose immunosuppressive therapy was added to their treatment protocols were admitted to the hospital later than others, had more prevalent involvement in thorax CT, high acute phase reactants, low SPO2, and more than one underlying disease. [ABSTRACT FROM AUTHOR]

Background: The novel coronavirus, which causes Covid-19 disease and is called severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) by the World Health Organization, was first seen in Wuhan, China in December 2019 and initiated a pandemic on a global scale. Uncontrolled cytokine production is observed in Covid-19 cases with severe progression, and this is thought to be one of the reasons for increased mortality. We applied Coupled Plasma Filtration Adsorption (CPFA) and Tocilizumab treatments to patients who were hospitalized in our intensive care unit due to Covid-19 disease and who thought that cytokine release syndrome and/or cytokine storm developed after the uncontrolled cytokine production triggered by the SARS-CoV-2 virus. In our study, we aimed to evaluate the effectiveness of these treatments through retrospective file and archive scanning. Materials and Methods: Patients who had hospitalized in our intensive care unit between February and June 2020 due to Covid-19 disease, were thought to have developed cytokine release syndrome and/or cytokine storm, and were treated with CPFA or Tocilizumab were included in our study. Our study was planned by retrospectively scanning the data of 20 patients from each treatment group. CPFA treatments were applied for 10 hours each session and 2 sessions with a 12-hour break. Tocilizumab administration was made intravenously within 1 hour from 8 mg/kg dose to a maximum of 800 mg. Before CPFA and Tocilizumab treatments and in the 24th, 48th hour and 7th day after CPFA and Tocilizumab treatments, Sequential Organ Failure Assessment scores(SOFA), Horowitz indexes(PaO2/FiO2), fever, inotrope requirements, SpO2 and relevant laboratory values (IL-6, Lymphocyte count, CRP, D-dimer) were obtained from patient files and systemic data. Results: After CPFA and Tocilizumab treatments, a decrease in fever and IL-6 values, an increase in SpO2 and lymphocyte values, an increase in Horowitz and SOFA scores, and a decrease in CRP and D dimer values were observed. The increase in SpO2 and Horowitz score values was significantly higher in the CPFA group. At the end of the 7th day, a decrease in fever values and an increase in SOFA scores and a decrease in CRP - D dimer values were significantly more pronounced in the CPFA group. A decrease in inotropic support was observed in the CPFA group. Conclusion: In Covid-19 disease, the disease has a more severe course with cytokine release syndrome and/or cytokine storm that develops after the deterioration of the immune system. Inflammatory cytokine production was controlled with CPFA and Tocilizumab treatments, and improvements were achieved in the oxygenation and clinical findings of the patients. [ABSTRACT FROM AUTHOR]

In December 2019, a novel coronavirus (SARS-CoV-2) was identified as the cause of clustered pneumonia cases in Wuhan, a city in the Hubei Province of China. The virus rapidly spread to the rest of the world after a huge epidemic in China and WHO has declared a pandemic on March 11, 2020. SARS-CoV-2 is transmitted via respiratory droplets and fomites during close unprotected contact. The airborne spread has not been established as a major route of transmission. The mean incubation period of the illness is 5 days and it mainly presents with fever and respiratory symptoms. Myalgia, loss of taste and smell, diarrhea and dermatological findings are also common during the course of the disease. Laboratory findings are nonspecific. Significant elevations in inflammation markers can be observed in some patients due to cytokine storm. Typical CT findings are bilateral ground glass opacities and consolidation with peripheral and lower lobes distribution. COVID-19 causes mild symptoms in most cases, however it may progress to severe pneumonia leading to ARDS and death, especially in those with advanced age and comorbid diseases. There is no specific effective antiviral treatment for COVID-19. A number of in vitro effective agents have been identified. These agents such as chloroquine phosphate/hydroxychloroquine, favipiravir, remdesivir, lopinavir/ritonavir are widely used in the treatment of the disease. Convalescent plasma therapy and the cytokine inhibitory agents such as tocilizumab, used to treat disease-induced cytokine storm, are particularly preferred in the treatment severe cases. [ABSTRACT FROM AUTHOR]

Macrophage activation syndrome is a life-threatening condition resulting from the destruction of organs and tissues secondary to excessive activation of the immune system. The cytokine storm that develops during a corona virus infection has some overlapping laboratory and clinical findings to the hemophagocytic syndrome. It is curcial to support the diagnosis and differential diagnosis of this disease with successive measurements of the inflammation markers so as to initiate the treatment process immediately. We have reported here the case of a 44-yearold patient who was treated with tocilizumab for hemophagocytic syndrome that developed during his corona virus infection. The patient was sucessfully treated and monitored as per the pandemic requirement and then discharged. He showed no sequela and has completely recovered. [ABSTRACT FROM AUTHOR]

Objective: In this retrospective study, we assessed if the admission levels of interleukin (IL)-6 and other inflammatory parameters corralate with the extension of lung involvement on computed tomography (CT) in severe-critical COVID patients. Materials and Methods: Ninety patients with a diagnosis of COVID-19 in the intensive care unit were included; however, 30 of these patients who were diagnosed as COVID-19 [polymerase chain reaction (PCR), CT, or history-clinical presentation-laboratory] and whose CT and IL-6 inflamatory parameter results could be obtained were finally analyzed. Admission CT scan findings were analyzed according to a 40-point system, and compared to the admission levels of plasma IL-6 as well as c-reactive protein, procalcitonin, lymphocyte, and neutrophyl/lymphocyte ratios. Results: No correlation was found between the IL-6 levels and CT scores taken in the same time period. IL-6 levels were corraleted with procalcitonin levels and mortality rate ssuggesting that bacterial infections were supervened on the clinical scene of these patients. Conclusion: In our study, we could not show any correlation between CT scores and an elevation of IL-6 levels. The role of the cytokine storm in COVID-19 pneumonia that manifests with cell death, thrombotic sequences, and alveolar edema might be explained by ongoing studies. [ABSTRACT FROM AUTHOR]