ToolsCalculators
Cytokine release syndrome (CRS) grading
ASTCT consensus grade of CRS from fever, hypotension and hypoxia.
Cytokine release syndrome (CRS) grading
Fever >=38 C (at or since onset)
Hypotension
Hypoxia / oxygen requirement
ResultNo CRS
No fever, hypotension or hypoxia attributable to CRS.
When to use
- Grading CRS severity after CAR T-cell or other T-cell-engaging immunotherapy to guide tocilizumab and supportive care.
Formula
Fever >=38 C is required for grade 1. Grade is then set by the more severe of hypotension and hypoxia: grade 2 (fluid-responsive hypotension and/or low-flow O2), grade 3 (one vasopressor and/or high-flow O2/mask), grade 4 (multiple vasopressors and/or positive-pressure ventilation).
Pearls and pitfalls
- After antipyretics or tocilizumab, grade is driven by hypotension/hypoxia even if fever has resolved.
- Vasopressin is excluded when counting vasopressors for grade 4.