[Interdisciplinary COVID board for patients with SARS-CoV-2-triggered hyperferritinemic Inflammation]

BACKGROUND: Patients with severe COVID-19 develop hyperferritinemic inflammation, a rare sepsis-like immune dysregulation syndrome METHODS: Stratified treatment decisions in a cross-location telemedical interdisciplinary case conference were assessed in this retrospective cohort study A standardized treatment algorithm including continuous positive airway pressure and noninvasive ventilation was implemented A locally developed COVID inflammation score (CIS) defined patients at risk for severe disease Patients with life-threatening inflammation were offered off-label treatment with the immune modulator ruxolitinib RESULTS: Between 4 March 2020 and 26 June 2020 COVID-19 patients (n = 196) were treated Median patient age (70 years) and comorbidity were high in interstudy comparison Mortality in all patients was 17 3% However, advance care planning statements and physician directives limited treatment intensity in 50% of the deceased patients CIS monitoring of ruxolitinib-treated high-risk patients (n = 20) on days 5, 7, and15 resulted in suppression of inflammation by 42% (15-70), 54% (15-77) and 60% (15-80) Here, mortality was 20% (4/20) Adjusted for patients with a maximum care directive including ICU, total mortality was 8 7% (17/196) CONCLUSION: Severe COVID-19 pneumonia with hyperferritinemic inflammation is related to macrophage activation syndrome-like sepsis An interdisciplinary intensive care teleconference as a quality tool for ICUs is proposed to detect patients with rare sepsis-like syndromes Publisher: Abstract available from the publisher ger