- age below 18 years - denial for written informed consent - any stage iv malignancy - any do not resuscitate decision - αny po2/fio2 (partial oxygen pressure to fraction of inspired oxygen) ratio less than 150 mmhg irrespective if the patient is under mechanical ventilation (mv) / non-invasive ventilation (niv) / extracorporeal membrane oxygenation (ecmo) or not - patient under mv or niv or ecmo - any primary immunodeficiency - less than 1,500 neutrophils/mm3 - plasma supar less than 6 ng/ml - known hypersensitivity to anakinra - oral or iv intake of corticosteroids at a daily dose equal or greater than 0.4 mg/kg prednisone for a period greater than the last 15 days. - any anti-cytokine biological treatment the last one month - severe hepatic failure defined as child-pugh stage of 3 - end-stage renal failure necessitating hemofiltration or peritoneal hemodialysis - pregnancy or lactation. women of child-bearing potential will be screened by a urine pregnancy test before inclusion in the study - participation in any other interventional trial

- age below 18 years - denial for written informed consent - any stage iv malignancy - any do not resuscitate decision - αny po2/fio2 (partial oxygen pressure to fraction of inspired oxygen) ratio less than 150 mmhg irrespective if the patient is under mechanical ventilation (mv) / non-invasive ventilation (niv) / extracorporeal membrane oxygenation (ecmo) or not - patient under mv or niv or ecmo - any primary immunodeficiency - less than 1,500 neutrophils/mm3 - plasma supar less than 6 ng/ml - known hypersensitivity to anakinra - oral or iv intake of corticosteroids at a daily dose equal or greater than 0.4 mg/kg prednisone for a period greater than the last 15 days. - any anti-cytokine biological treatment the last one month - severe hepatic failure defined as child-pugh stage of 3 - end-stage renal failure necessitating hemofiltration or peritoneal hemodialysis - pregnancy or lactation. women of child-bearing potential will be screened by a urine pregnancy test before inclusion in the study - participation in any other interventional trial