Home Care Follow up determine the point of inversion of IL-6 levels in relation to C-Reactive Protein as the cytokine storm marker in COVID-19
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The SARS-CoV-2 pandemic emerged as the cause of a life-threatening severe acute respiratory syndrome (SARS) disease triggered by a remarkable and uncontrolled pulmonary inflammation known as a “cytokine storm”. IL-6 has been used for the characterization of the cytokine storm induced by SARS-CoV-2, but so far, no one has found out when and in whom the cytokine storm develops. In addition, the hypoxemia has been the criterion for cytokine storm and the administration of corticosteroids in severe COVID-19. The present study, which was carried out in Porto Velho, Rondônia State, in the western Brazilian Amazon demonstrates how early and longitudinal clinical-based monitoring and dosing of five markers (C-reactive protein, IL-6, fibrinogen, ferritin and D-dimer) helped to identify who ´d developed the cytokine storm and how therapeutic contributed to decrease the mortality rates from COVID-19. Longitudinal monitoring of inflammatory markers guided the treatment of COVID-19 based on three pillars: antibiotic treatment, anticoagulant therapy, and administration of pulsetherapy. The medical team of the Multidisciplinary Home Medical Care Service (HMCS) of the Department of Health of the state of Rondônia carried out the telemonitoring and, when necessary, carried out face-to-face visits. The treatment was also personalized at home by a HMCS nursing team that collected vital signs and administered medications. As the main results, the administration of antibiotic therapy, anticoagulant therapy and pulse therapy resolved the infection for those with potential for severe COVID-19 and prevented the progressive deterioration of the lung injury. Our findings demonstrate that showed increases in IL-6 and CRP levels, and the peak of IL-6 in pg/mL was proportionally higher than the peak of CRP in mg/L were sufficient to define the timing of the evolution of cytokine storm syndrome and prevent the progressive deterioration of the lung function. The administration of antibiotic therapy, anticoagulant therapy and pulse therapy resolved the infection of the patients with potential for development of severe COVID-19, e.g. the cytokine storm, and showed to be very effective in reducing the risk of death.