Table 3

2018 CRS consensus grading by Lee et al 69

Grade 1Fever* ≥38°C—symptomatic management—intravenous fluids, analgesics, antiemetics, antipyretics possibly antibiotics and a lot of careful watching from the nurses and caregivers and the team.
Grade 2Fever* ≥38°C, grade 2 creatinine elevation, grade 3 transaminitis, neutropenic fevers and other indications for hospitalization, with hypotension not requiring vasopressors and/or hypoxia requiring low-flow nasal cannula or blow-by oxygen.
Grade 3Fever* ≥38°C, grade 3 creatinine elevation, grade 4 transaminitis, with hypotension requiring one vasopressor with or without vasopressin and/or hypoxia requiring high-flow nasal cannula, facemask, non-rebreather mask, or Venturi mask not attributable to any other cause.
Grade 4Fever* ≥38°C, as life-threatening symptoms requiring ventilator support or grade 4 organ toxicity, with hypotension requiring multiple vasopressors (excluding vasopressin) and/or hypoxia requiring positive pressure (eg, CPAP, BiPAP, intubation and mechanical ventilation) not attributable to any other cause.
Grade 5Death
  • *Fever is defined as temperature ≥38°C. In patients who have CRS then receive tocilizumab or steroids, fever is no longer required to grade subsequent CRS severity. In this case, CRS grading is driven by hypotension and/or hypoxia.

  • CRS, cytokine release syndrome; CPAP, continuous positive airway pressure; BiPAP, bilevel positive airway pressure.