eprintid: 10132581 rev_number: 18 eprint_status: archive userid: 608 dir: disk0/10/13/25/81 datestamp: 2021-08-10 10:29:17 lastmod: 2022-07-16 06:10:29 status_changed: 2021-08-10 10:29:17 type: article metadata_visibility: show creators_name: Mehta, P creators_name: Fajgenbaum, DC title: Is severe COVID-19 a cytokine storm syndrome: a hyperinflammatory debate ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: K71 note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. abstract: PURPOSE OF REVIEW: The COVID-19 pandemic is a global public health crisis with considerable mortality and morbidity. A role for cytokine storm and therapeutic immunomodulation in a subgroup of patients with severe COVID-19 was proposed early in the pandemic. The concept of cytokine storm in COVID-19 has been criticised, given the lack of clear definition and relatively modest cytokinaemia (which may be necessary for viral clearance) compared with acute respiratory distress syndrome and bacterial sepsis. Here we consider the argument for and against the concept of cytokine storm in COVID-19. RECENT FINDINGS: Several criteria have been proposed to identify the subgroup of COVID-19 patients exhibiting a cytokine storm. The beneficial effect of corticosteroids and interleukin-6 inhibition suggest that inflammation is a modifiable pathogenic component of severe COVID-19. The presence of genetic polymorphisms and pathogenic auto-autoantibodies in severe COVID-19 also suggests a significant contribution of immune dysregulation to poor outcomes. SUMMARY: Hyperinflammation is a key component of severe COVID-19, residing underneath the cytokine storm umbrella term, associated with poor outcomes. Better understanding of the aetiopathogenesis, with identification of biomarkers to predict treatment responses and prognosis, will hopefully enable a stratified and ultimately precision medicine approach. date: 2021-09 date_type: published official_url: https://doi.org/10.1097/BOR.0000000000000822 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green article_type_text: Journal Article verified: verified_manual elements_id: 1878575 doi: 10.1097/BOR.0000000000000822 pii: 00002281-900000000-98886 lyricists_name: Mehta, Puja lyricists_id: PMEHT16 actors_name: Mehta, Puja actors_id: PMEHT16 actors_role: owner full_text_status: public publication: Current Opinion in Rheumatology volume: 5 pagerange: 419-430 event_location: United States citation: Mehta, P; Fajgenbaum, DC; (2021) Is severe COVID-19 a cytokine storm syndrome: a hyperinflammatory debate. Current Opinion in Rheumatology , 5 pp. 419-430. 10.1097/BOR.0000000000000822 <https://doi.org/10.1097/BOR.0000000000000822>. Green open access document_url: https://discovery-pp.ucl.ac.uk/id/eprint/10132581/3/Mehta_Is%20severe%20COVID-19%20a%20cytokine%20storm%20syndrome-%20a%20hyperinflammatory%20debate_AAM.pdf