Impact of cytokine storm on severity of COVID-19 disease in a private hospital in West Jakarta prior to vaccination

• Published in: PloS one 2022-01, Vol.17 (1), p.e0262438-e0262438
• Main Authors: Ramatillah, Diana Laila, Gan, Siew Hua, Pratiwy, Ika, Syed Sulaiman, Syed Azhar, Jaber, Ammar Ali Saleh, Jusnita, Nina, Lukas, Stefanus, Abu Bakar, Usman
• Format: Article
• Language: English
• Subjects: Adenosine Monophosphate - administration & dosage; Adenosine Monophosphate - analogs & derivatives; Adenosine Monophosphate - therapeutic use; Adult; Age; Aged; Alanine - administration & dosage; Alanine - analogs & derivatives; Alanine - therapeutic use; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - therapeutic use; Antiviral drugs; Azithromycin; Biology and Life Sciences; Brittleness; Comorbidity; Coronaviruses; Cough; COVID-19; COVID-19 - complications; COVID-19 - drug therapy; COVID-19 - pathology; COVID-19 vaccines; Cytokine Release Syndrome - drug therapy; Cytokine Release Syndrome - epidemiology; Cytokine Release Syndrome - etiology; Cytokine Release Syndrome - pathology; Cytokine storm; Cytokines; Data collection; Diabetes; Diabetes mellitus; Ethics; Fatalities; Female; Fever; Global health; Health aspects; Health risks; Health services; Hospitals; Hospitals, Private - statistics & numerical data; Humans; Hydroxychloroquine; Hypertension; Immunization, Passive - statistics & numerical data; Indonesia; Infections; Inflammation; Interleukin 6; Levofloxacin; Male; Medical records; Medical treatment; Medicine and Health Sciences; Middle Aged; Minerals; Oseltamivir; Oxygen; Oxygen content; Pandemics; Patients; Pharmaceutical sciences; Pharmacy; Physiological aspects; Public health; Respiratory distress syndrome; Sampling methods; Signs and symptoms; Survival; Survival analysis; Vaccination; Vaccination - statistics & numerical data; Ventilators; Viral diseases; Vitamins; Vitamins - administration & dosage; Vitamins - therapeutic use
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0262438

Coronavirus Disease 2019 (COVID-19) has become a worldwide pandemic and is a threat to global health. Patients who experienced cytokine storms tend to have a high mortality rate. However, to date, no study has investigated the impact of cytokine storms. This retrospective cohort study included only COVID-19 positive patients hospitalized in a Private Hospital in West Jakarta between March and September 2020. All patients were not vaccinated during this period and treatment was based on the guidelines by the Ministry of Health Indonesia. A convenience sampling method was used and all patients who met the inclusion criteria were enrolled. The clinical outcome of COVID-19 patients following medical therapy was either cured (85.7%) or died (14.3%), with 14.3% patients reported to have cytokine storm, from which 23.1% led to fatalities. A plasma immunoglobulin (Gammaraas®) and/or tocilizumab (interleukin-6 receptor antagonist; Actemra®) injection was utilised to treat the cytokine storm while remdesivir and oseltamivir were administered to ameliorate COVID-19. Most (61.5%) patients who experienced the cytokine storm were male; mean age 60 years. Interestingly, all patients who experienced the cytokine storm had hypertension or/ and diabetes complication (100%). Fever, cough and shortness of breath were also the common symptoms (100.0%). Almost all (92.3%) patients with cytokine storm had to be treated in the intensive care unit (ICU). Most (76.9%) patients who had cytokine storm received hydroxychloroquine and all had antibiotics [1) azithromycin + levofloxacin or 2) meropenam for critically ill patients] and vitamins such as vitamins C and B-complex as well as mineral. Unfortunately, from this group, 23.1% patients died while the remaining 70% of patients recovered. A significant (p