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    Chief Complaint


    Organ System


    Patent Pending

    Cytokine Release Syndrome (CRS) Grading

    Assesses severity of CRS in patients on immunotherapy.


    Use in patients receiving immunotherapy for cancer.

    When to Use
    Why Use

    Patients receiving immunotherapy for cancer with signs of cytokine-mediated immunological reactions and multi-organ dysfunction.

    • Do not forget coagulopathy as organ dysfunction.

    • High-dose vasopressors need to be on board for ≥3 hours in order to be assigned grade 3.

    • Consider corticosteroids at 24 hours if no improvement.

    • Most patients receiving immunological therapies have complicated ongoing processes and require specialized care. Clinical expertise, vigilance, and frequent follow-up are key to recognizing CRS and not attributing signs and symptoms to an alternate cause (e.g. infection).

    Helps guide interventions for patients receiving immunological therapies for cancer.

    Symptoms not life-threatening; only symptomatic treatment required (fever, nausea, fatigue, headache, myalgias, malaise)
    Moderate intervention required for response: oxygen requirement <40%, hypotension responsive to fluids, low dose of one pressor, or grade 2 organ toxicity
    Aggressive intervention required for response: oxygen requirement ≥40%, hypotension requiring high dose/multiple pressors, grade 3 organ toxicity, or grade 4 transaminitis
    Life-threatening symptoms: ventilator required, or grade 4 organ toxicity (excluding transaminitis)


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    Next Steps
    Creator Insights


    Clinical judgment should be exercised at all times regarding the observed time course of symptoms and the patient's functional reserve. Tailoring interventions and moving to second-line agents, ruling out other causes, and follow-up are key.


    • Monitoring and aggressive supportive care should be considered in order to prevent irreversible end-organ damage.

    • Consider ICU setting (1:1 nursing care).

    • Consider involving expert consultative services.

    Critical Actions

    Always investigate for alternate causes such as infection, tumor lysis syndrome, or organ dysfunction. Always evaluate for end-organ damage.

    Content Contributors
    • Joseph Maakaron, MD
    About the Creator
    Dr. Daniel W. Lee
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    Content Contributors
    • Joseph Maakaron, MD