Notably, inflammatory cytokines, including IL-6 and TNF-α, proinflammatory/anti-inflammatory ratios (IL-6/IL-10, and IL-6/IL-4) unexpectedly kept increased within 5 days of CP treatment in almost half of patients, which was not compatible with another study on CP treatment for COVID-19.13 It is probably because that increased systemic cytokine production may lead to the pathophysiology of severe COVID-19, including ARDS and multiple organ failure,28 and it might be unable to attenuate the inflammatory damage soon after CP transfusion. This evidence concerns the gene TNF and acute respiratory distress syndrome.