Comparison of criteria for CRS grades between the Penn, Lee, and ASTCT Scales
| Grade . | Penn Scale (Porter et al)13 . | Lee Scale (Lee et al)18 . | ASTCT (Lee et al)2 . |
|---|---|---|---|
| Grade 1 | • Mild reaction treated with supportive care only | • Symptoms are not life-threatening and require symptomatic treatment only (eg, fever, nausea, fatigue, headache, myalgias, malaise) | • Fever (temperature ≥38°C) |
| • No hypotension and/or hypoxia | |||
| Grade 2 | • Moderate reaction requiring IV therapies or parenteral nutrition | • Symptoms require and respond to moderate intervention | • Fever (temperature ≥38°C) |
| • Mild signs of organ dysfunction (creatinine ≤ grade 2 or LFT results ≤ grade 3) | • Oxygen requirement <40%* or hypotension responsive to fluids or low-dose pressors or grade 2 organ toxicity | • Hypotension not requiring vasopressors | |
| • Hospitalization for CRS or febrile neutropenia | • Hypoxia requiring low-flow (≤6 L/min) nasal cannula† or blow-by | ||
| Grade 3 | • More severe reaction requiring hospitalization | • Symptoms require and respond to aggressive intervention | • Fever (temperature ≥38°C) |
| • Moderate signs of organ dysfunction (grade 3 creatinine or grade 4 LFT results) related to CRS | • Oxygen requirement ≥40% or hypotension requiring high-dose or multiple pressors or grade 3 organ toxicity or grade 4 transaminitis | • Hypotension requiring vasopressors with or without vasopressin | |
| • Hypotension treated with IV fluids‡ or low-dose pressors | • Hypoxia requiring high-flow (>6 L/min) nasal cannula,† facemask, nonrebreather mask, or Venturi mask | ||
| • Hypoxemia requiring oxygenation, BiPAP, or CPAP | |||
| Grade 4 | • Life-threatening complications, including hypotension requiring high-dose vasopressors or hypoxemia requiring mechanical ventilation | • Life-threatening symptoms | • Fever (temperature ≥38°C) |
| • Requirement for ventilator support or grade 4 organ toxicity (excluding transaminitis) | • Hypotension requiring multiple vasopressors (excluding vasopressin) | ||
| • Hypoxia requiring positive pressure (eg, CPAP, BiPAP, intubation and mechanical ventilation) |
| Grade . | Penn Scale (Porter et al)13 . | Lee Scale (Lee et al)18 . | ASTCT (Lee et al)2 . |
|---|---|---|---|
| Grade 1 | • Mild reaction treated with supportive care only | • Symptoms are not life-threatening and require symptomatic treatment only (eg, fever, nausea, fatigue, headache, myalgias, malaise) | • Fever (temperature ≥38°C) |
| • No hypotension and/or hypoxia | |||
| Grade 2 | • Moderate reaction requiring IV therapies or parenteral nutrition | • Symptoms require and respond to moderate intervention | • Fever (temperature ≥38°C) |
| • Mild signs of organ dysfunction (creatinine ≤ grade 2 or LFT results ≤ grade 3) | • Oxygen requirement <40%* or hypotension responsive to fluids or low-dose pressors or grade 2 organ toxicity | • Hypotension not requiring vasopressors | |
| • Hospitalization for CRS or febrile neutropenia | • Hypoxia requiring low-flow (≤6 L/min) nasal cannula† or blow-by | ||
| Grade 3 | • More severe reaction requiring hospitalization | • Symptoms require and respond to aggressive intervention | • Fever (temperature ≥38°C) |
| • Moderate signs of organ dysfunction (grade 3 creatinine or grade 4 LFT results) related to CRS | • Oxygen requirement ≥40% or hypotension requiring high-dose or multiple pressors or grade 3 organ toxicity or grade 4 transaminitis | • Hypotension requiring vasopressors with or without vasopressin | |
| • Hypotension treated with IV fluids‡ or low-dose pressors | • Hypoxia requiring high-flow (>6 L/min) nasal cannula,† facemask, nonrebreather mask, or Venturi mask | ||
| • Hypoxemia requiring oxygenation, BiPAP, or CPAP | |||
| Grade 4 | • Life-threatening complications, including hypotension requiring high-dose vasopressors or hypoxemia requiring mechanical ventilation | • Life-threatening symptoms | • Fever (temperature ≥38°C) |
| • Requirement for ventilator support or grade 4 organ toxicity (excluding transaminitis) | • Hypotension requiring multiple vasopressors (excluding vasopressin) | ||
| • Hypoxia requiring positive pressure (eg, CPAP, BiPAP, intubation and mechanical ventilation) |
BiPAP, biphasic positive air pressure; CPAP, continuous positive air pressure; LFT, liver function test.
At 5 L/min, the approximate fraction of inspired oxygen is 40%.
Low-flow nasal cannula defined as oxygen delivered at ≤6 L/min. Low flow includes blow-by oxygen delivery, sometimes used in pediatrics. High-flow nasal cannula is defined as oxygen delivered at >6 L/min.
Defined as multiple fluid boluses for blood pressure support.