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here are my current thoughts on cytokine storm diagnosis, higher dose steroid, and tocilizumab. this *isn't* strongly evidence-based, so if you're an EBM stickler please don't read this thread...(1/5)
(more in IBCC: https://bit.ly/2JL2wr4 )
(more in IBCC: https://bit.ly/2JL2wr4 )
some patients present with, or develop, high levels of inflammatory markers & associated labs (e.g. CRP, ferritin, D-dimer, and LDH). many studies predict that these patients will fare poorly. and indeed, despite high-quality supportive care, these patients will often die.(2/5)
the best approach is undoubtedly to enroll such patients in RCTs. however, most centers don't currently have access to such trials. the remainder of this thread is intended for centers *without* the ability to enroll patients in an RCT. (3/5)
for patients embarking down a pathway of cytokine-driven organ failure, it seems sensible to try some sort of anti-inflammatory therapy. I don't claim to know the best one (steroid? tocilizumab?). but 1 mg/kg prednisone QD or equivalent doesn't seem to cut it here (4/5)
yes, I know the evidence supporting this is very poor. this may seem desperate, and perhaps it's the wrong thing to do. it's intended merely as an attempt to throw a rope to these patients who are failing basic supportive therapy, pending the availability of better data (5/5)
