Cytokine Storm in COVID-19

Brian T. Garibaldi, MD, FRCP(E)Director, Johns Hopkins Biocontainment Unit

Director, JH COVID-19 Precision Medicine Center of Excellence

6/2/2020 1

The JH Biocontainment Unit

6/2/2020 2

Regional Ebola and Special Pathogen

Treatment Centers (RESPTCs)

6/2/2020 3

The Hopkins BCU Vision

June 2, 2020 4

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Patient

• 42 y/o male with 4-day history of fever

and cough

• Recent travel to Florida 1 week before

• No significant PMH

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T 38.9 RR 44 P 115 BP 119/59 92% NRB

6/2/2020 7

6/2/2020

8

Lab Highlights

• D-dimer>30 mg/L FEU

• Fibrinogen 914 mg/dl

• Absolute lymphocyte count 690 K/cu mm

• CRP 21.5 mg/dl

• IL-6 905 pg/ml

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Clinical Course

• Intubated for 26 days

• Proned multiple times

• Mildly reduced EF

• Left brachial vein DVT

• Ventilator associated pneumonia

• Prolonged delirium

• 50-pound weight loss

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Trajectory for Patient

11

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DEATH

MILD/

MODERATE

SEVERE

832 COVID-19 + patients

March 12, 2020 to April 24,

2020

Severe Disease

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COVID-19

Hyperinflammatory Syndrome

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Preventing Cytokine Storm

• ACTT-1

Remdesivir vs.

Placebo

• ACTT-2

Remdesivir +

Baricitinib or Placebo

• Convalascent

Plasma

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Clinical Trials for Cytokine

Storm at Johns Hopkins

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Tocilizumab at JHH

• Out of first 832 patients, 39 (5%)

received tocilizumab

• 6 died, 29 had severe disease, 4 never

progressed beyond mild disease

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The JH-CROWN Team

CCDA• Bonnie Woods

• David Thiemann

• Masoud Rouhizadeh

• Scott Carey

PMAP• Ken Harkness

• Paul Nagy

• Mariam Ghobadi-Krueger

• Aalok Shah

• Phil Gianuzzi

• Christopher Doyle

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Bloomberg SPH• Scott Zeger

• John Muschelli

• Jacob Fiksel

• Karen Bandeen Roche

• Mary Grace Bowring

• Martina Fu

• Yizhen Xu

• Zitong Wang

• Emily Scott

SOM• Brian Garibaldi

• Antony Rosen

• Amita Gupta

• Matt Robinson

• Timothy Niessen

• Ashwini Davison

• Josh Gray

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