LDH elevation in severe COVID-19 characterized by cytokine release syndrome reflects extended inflammasome activation of the Nod-Like Receptor Protein (NLRP-3) pathway, with other immune abnormalities including chemokines, Il-1β, nuclear factor kappa beta, IL-18, caspase-1, and damage associated molecular patterns (DAMPs). The gene discussed is IL18; the disease is COVID-19.