Characterization and therapeutic management of immune hyperactivation associated with mortality in COVID-19

The clinical deterioration of the SARS-CoV-2 infection would be the result of a combination of direct cytopathic effects induced by the virus and the immunopathology induced by a cytokine release syndrome associated with the immune response against the virus. The experience that is being acquired in our centers indicates that in the most serious cases the clinical picture is mainly related to the activation of an exaggerated immune response and an uncontrolled inflammatory process, which leads to multi-organ failure that ends in death. A recent study of 150 confirmed cases of COVID-19 in Wuhan, has just identified elevated ferritin and IL-6 as the main predictors of mortality, confirming that the hyperinflammation caused by the response to SARS-CoV-2 would be the leading cause of death in COVID-19. Our project aims to carry out an exhaustive study of the patient's immune status: i) establishing early cytokine monitoring to guide the targeted and personalized use of biological drugs, in order to rescue patients with a worse evolution from probable death; ii) studying the immunological factors associated with relative risk, progression and also with the development of immunity against the virus.