Phase 3 (severe)
The third stage is the most serious, which can lead to the death of the patient. In this phase there is a hyperactive and systemic (not only lung) inflammatory state which is called Cytokine Storm (CS) and that can appear in the patient and, briefly, lead to respiratory distress syndrome (ARDS). In this phase inflammation marker values (IL-2, IL-6, GCSF, TNF-alpha, D-dimer, ferritin, etc.) are very high.
The patient may have severe respiratory failure and cardiac shock.
All the organs may see a worsened condition. Immunological therapies (corticosteroids, anti-interleukin 6, such as tocilizumab and sarilumab, IL-1 receptor antagonists such as anakinra or canakinumab, JAK-inhibitors, convalescent plasma) are necessaries at this stage to attempt the reduction of an aberrant storm cytokinic response. The prognosis for patients at this stage of disease is very severe (1-13)