Abstract

Objective: In COVID-19, cytokine storms (CS) result in higher mortality and morbidity. Our study evaluated the rate of cytokine storms among COVID-positive Bangladeshi adults.

Methods: From October 2020 to March 2022, this cohort study enrolled both COVID-positive and treated in a makeshift COVID unit of icdr,b Dhaka Hospital. CS was defined as having IL-6 >80 pg/mL or any three of the following: high CRP, ferritin, LDH, D-dimer, or low lymphocyte. Stored plasma samples were tested for the cytokines IL-6, IL-1, and TNF-.

Results: This study involved 77 participants, 32 were in the severe-critical group, 30 were in the mild-moderate group, and 14 were COVID-negative. Severe-critical COVID-19-positive patients were elderly, comorbid with chronic respiratory illness, hypertension, diabetes, and heart diseases, and often presented with fever, cough, and dyspnea compared to mild-moderate COVID-19-positive patients. When compared to mild to moderate COVID-19 cases, they had lower hemoglobin, red blood cells, platelet, and lymphocytes count but higher neutrophils (%), CRP, D-dimer, LDH, and ferritin level. Twelve participants in the severe-critical grouphad CS. Thus, the rate of CS was 37.5% (12/32). Compared to COVID-19-negative patients, COVID-19-positive patients had higher IL-6 levels, which decreased at discharge except for those dying. Among the COVID-19-positive patients, nine died. For both the mild-moderate and severe-critical patients, IL-6 increased with increasing CRP (p<0.001).

Conclusion: During the COVID-19 pandemic, Bangladeshi adults experienced a surge in cytokine storms. The rate of cytokine storm in Bangladeshi COVID-19-positive adults was 37.5%.