- patients with respiratory distress syndrome with arterial partial pressure of oxygen / fraction of inspired oxygen (pao2 / fio2) <200 mm/hg or - patients in non-invasive ventilation or - patients in invasive ventilation or presence of shock or presence of concomitant organ failure that requires admission to the intensive care unit - severe heart and kidney failure - pregnant or breastfeeding patient - patient who, in the opinion of the clinician or by the patient's express will, will not go to intensive care regardless of the evolution of the lung picture. - known hypersensitivity to tcz or its excipients - patient being treated with immuno-depressors or anti-rejection drugs - known active infections or other clinical conditions that contraindicate tcz and cannot be treated or resolved according to the physician's judgment - glutamate-pyruvate transaminase (gpt) or glutamine oxaloacetic transaminase (got) > 5 times the upper limit of the norm - neutrophils <500 /mmc - platelets <50.000 /mmc - diverticulitis or intestinal perforation - suspicion of latent tuberculosis

- patients with respiratory distress syndrome with arterial partial pressure of oxygen / fraction of inspired oxygen (pao2 / fio2) <200 mm/hg or - patients in non-invasive ventilation or - patients in invasive ventilation or presence of shock or presence of concomitant organ failure that requires admission to the intensive care unit - severe heart and kidney failure - pregnant or breastfeeding patient - patient who, in the opinion of the clinician or by the patient's express will, will not go to intensive care regardless of the evolution of the lung picture. - known hypersensitivity to tcz or its excipients - patient being treated with immuno-depressors or anti-rejection drugs - known active infections or other clinical conditions that contraindicate tcz and cannot be treated or resolved according to the physician's judgment - glutamate-pyruvate transaminase (gpt) or glutamine oxaloacetic transaminase (got) > 5 times the upper limit of the norm - neutrophils <500 /mmc - platelets <50.000 /mmc - diverticulitis or intestinal perforation - suspicion of latent tuberculosis