PDF(Pubmed)
Abstract：
Immune checkpoint inhibitors (ICIs) are linked to diverse immune-related adverse events (irAEs). Rare irAEs surface first in clinical practice. Here, we systematically studied the rare irAE, cytokine-release syndrome (CRS), in a cohort of 2672 patients treated with ICIs at Karolinska University Hospital in Stockholm, Sweden. We find that the risk of ICI-induced CRS - defined as fever, negative microbiological findings and absence of other probable causes within 30 days after ICI treatment - is approximately 1%, higher than previously reported. ICI-induced CRS was often mild and rechallenge with ICIs after mild CRS was generally safe. However, two out of 28 patients experienced high-grade CRS, and one was fatal. While C-reactive protein (CRP) and procalcitonin were not discriminative of fatal CRS, our data suggest that the quick Sequential Organ Failure Assessment (qSOFA) score might identify high-risk patients. These data provide a framework for CRS risk assessment and motivate multicenter studies to improve early CRS diagnosis.
摘要：
免疫检查点抑制剂（ICIs）与各种免疫相关的不良事件（irAE）有关。罕见的irAE首先在临床实践中出现。这里,我们系统地研究了罕见的IRAE，细胞因子释放综合征（CRS），在斯德哥尔摩卡罗林斯卡大学医院接受ICIs治疗的2672名患者中，瑞典。我们发现ICI诱导的CRS的风险-定义为发烧，ICI治疗后30天内微生物阴性和其他可能的原因-约为1％，高于以前的报道。ICI诱导的CRS通常是轻度的，在轻度CRS后用ICI再攻击通常是安全的。然而,28例患者中有2例经历过高级别CRS,一个是致命的。而C-反应蛋白（CRP）和降钙素原不能鉴别致死性CRS，我们的数据表明,快速序贯器官功能衰竭评估(qSOFA)评分可能识别高危患者.这些数据为CRS风险评估提供了框架，并激发了多中心研究以改善早期CRS诊断。
