Interleukin-6 blockade and cytokine release syndrome in coronavirus disease of 2019: Is that a lot? Thoughts from the emergency department

Cytokine storm remains the main feature in pathophysiology of the coronavirus disease 2019 (COVID-19) causing adverse effects from interleukin (IL) 1β, 6, and tumor necrosis factor-α. We are sharing some insights over the role of IL-6 driven immune dysregulation with anti-cytokine therapies targeting IL-1, 6, and tumor necrosis factor inhibitors (1,2). We believe that it is crucial for emergency physicians to be aware of the initial evaluation of IL-6 levels for patients with coronavirus disease due to its potential benefits and its supportive role in assessing worsening features and disease progression. Coronaviruses with an acute hyper-inflammatory syndrome can activate dysregulated host immune responses. It initiates cytokine release syndrome with clinical features such as fever, hypoxia and raised inflammatory markers. The key factor related to this syndrome is the increased production of IL-6 by the infected T cells, macrophages, and dendritic cells (1). Viral load with raised IL-6 levels in critically ill patients infected with coronavirus disease is worth observing. IL-6 had been under consideration for viral epidemics in the past and many reports have found high cytokine levels in such patients.