From the Guidelines
The diagnosis of a cytokine storm is established through a combination of clinical presentation and laboratory findings, including fever, widespread inflammation, organ dysfunction, and rapid deterioration, with laboratory diagnosis relying on elevated inflammatory markers such as high levels of cytokines, ferritin, C-reactive protein, and D-dimer, as outlined in recent studies 1.
Key Diagnostic Features
The clinical presentation of a cytokine storm typically includes:
- Fever
- Widespread inflammation
- Organ dysfunction
- Rapid deterioration Laboratory findings that support the diagnosis of a cytokine storm include:
- Elevated inflammatory markers, such as:
- High levels of cytokines (particularly IL-6, TNF-alpha, IL-1)
- Ferritin above 500 ng/mL
- C-reactive protein above 100 mg/L
- Elevated D-dimer
- Cytopenias (particularly lymphopenia)
- Elevated liver enzymes
- Lactate dehydrogenase (LDH)
- Triglycerides
Diagnostic Criteria
The H-Score or HLH-2004 criteria can help assess the probability of hemophagocytic lymphohistiocytosis, a condition often associated with cytokine storms 1.
Exclusion of Other Causes
Diagnosis requires excluding other causes of systemic inflammation, such as sepsis or malignancy, as these conditions can also present with similar laboratory findings 1.
Treatment
Prompt recognition is critical, as cytokine storms can rapidly progress to multi-organ failure, with treatment typically involving immunomodulatory agents like corticosteroids, IL-6 inhibitors (tocilizumab), or JAK inhibitors, depending on the underlying cause and clinical context 1.
From the FDA Drug Label
ACTEMRA® (tocilizumab) is an interleukin-6 (IL-6) receptor antagonist indicated for treatment of: ... Cytokine Release Syndrome (CRS) (1. 6) Adults and pediatric patients 2 years of age and older with chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome.
The diagnosis of a cytokine storm, also known as Cytokine Release Syndrome (CRS), is established by the presence of severe or life-threatening symptoms induced by an overactive immune response, such as those seen in CAR T cell-induced CRS. However, the FDA drug label for tocilizumab does not provide specific diagnostic criteria for cytokine storm. Key points:
- The label mentions CAR T cell-induced severe or life-threatening cytokine release syndrome as an indication for tocilizumab treatment.
- It does not provide a definition or diagnostic criteria for cytokine storm. 2
From the Research
Diagnosis of Cytokine Storm
The diagnosis of a cytokine storm is established by a combination of clinical and biochemical criteria.
- Clinical criteria include the worsening of symptoms, such as respiratory distress, and the alteration of biological parameters on days 8-12 of the disease 3.
- Biochemical criteria include elevated levels of inflammatory markers, such as:
Laboratory Tests
Laboratory tests, such as CRP, LDH, and ferritin, are used to monitor the severity of the cytokine storm and the response to treatment 3, 4.
- These tests can help identify patients who are at high risk for severe disease and may benefit from immunomodulatory therapy.
Clinical Considerations
Clinical considerations, such as the presence of sepsis and respiratory failure, can also influence the diagnosis and treatment of cytokine storm 5.