ArticleCell host & microbe2020
Complex Immune Dysregulation in COVID-19 Patients with Severe Respiratory Failure.
Article in Cell host & microbe, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 1,362 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluation of Clinical Parameters Following COVID-19 Infection in Pregnancy (COpregVID)
Alterations of Innate and Adaptive Immune Cells During the Course of SARS CoV-2 Pneumonia
Immune Modulation by Stem Cell Derived Exosomes in Critically Ill COVID-19
Correlation of Lung Ultrasonography With Chest CT Findings in Cancer Patients With COVID-19 Viral Pneumonia, an Observational Study
Who cites it
1,362 citing papers in PubMed, 4 syntheses or guidelines pooled it, 2,244 citations in OpenAlex.
- Immunoinflammatory evidence of rheumatoid arthritis caused by COVID-19.Biological research · 2025Pooled it
- Update prognostic potency of surfactant protein D (SP-D) in the COVID-19 landscape: an In-depth meta-analytical exploration.Biomarkers in medicine · 2024Pooled it
- Pathophysiological Mechanisms in Long COVID: A Mixed Method Systematic Review.International journal of environmental research and public health · 2024Pooled it
- Association of interleukin-6, ferritin, and lactate dehydrogenase with venous thromboembolism in COVID-19: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Levels of circulating kidney injury markers and IL-10 identify non-critically ill patients with COVID-19 at risk of death.JCI insight · 2026Trial
- Pharmacodynamic, prognostic, and predictive biomarkers in severe and critical COVID-19 patients treated with sirukumab.Scientific reports · 2024Trial
- Transitions of blood immune endotypes and improved outcome by anakinra in COVID-19 pneumonia: an analysis of the SAVE-MORE randomized controlled trial.Critical care (London, England) · 2024Trial
- Standardized Brazilian green propolis extract (EPP-AF®) in COVID-19 outcomes: a randomized double-blind placebo-controlled trial.Scientific reports · 2023Trial
- Metabolic control of macrophages in coronavirus disease 2019.Virulence · 2026Review
- Monocytes in pneumonia: Functional plasticity and innate memory (Review).International journal of molecular medicine · 2026Review
- Systems genetics analysis reveals immune mediators of coronavirus disease severity in mice.Genetics · 2026Article
- Folic Acid and Endothelial Dysfunction in COVID-19.Life (Basel, Switzerland) · 2026Review
- Identification and functional characterization of regulatory variants in DPP9 associated with COVID-19 severity.Genome medicine · 2026Article
- Bone marrow hemophagocytosis in patients with hematological malignancies and COVID-19 infections: mimicry or secondary HLH?Journal of hematopathology · 2026Article
- Opposing Association of Lung Neutrophils and PD-L1Aging cell · 2026Article
- An Iron-Complement Network Model of Thromboinflammation and Humoral Immune Remodeling in Severe COVID-19.Current issues in molecular biology · 2026Article
- Inflammatory and Endothelial Dysfunction Biomarkers Predict Severe COVID-19 in Hospitalized Patients: Development of the CCBR Model.Biomedicines · 2026Article
- Machine Learning Identification of Cell-Type-Specific Molecular Signatures Distinguishing COVID-19 from Other Lower Respiratory Tract Diseases.Life (Basel, Switzerland) · 2026Article
- Spatiotemporal and Demographic Patterns of West Nile Neuroinvasive Disease in Vojvodina, Serbia, 2012-2025.Viruses · 2026Article
- The Resistance Paradox in COVID-19 Ventilator-Associated Pneumonia: A Retrospective Study on Rapid Molecular Stewardship.Antibiotics (Basel, Switzerland) · 2026Article
1,302 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
28 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Proper management of COVID-19 mandates better understanding of disease pathogenesis. The sudden clinical deterioration 7-8 days after initial symptom onset suggests that severe respiratory failure (SRF) in COVID-19 is driven by a unique pattern of immune dysfunction. We studied immune responses of 54 COVID-19 patients, 28 of whom had SRF. All patients with SRF displayed either macrophage activation syndrome (MAS) or very low human leukocyte antigen D related (HLA-DR) expression accompanied by profound depletion of CD4 lymphocytes, CD19 lymphocytes, and natural killer (NK) cells. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) production by circulating monocytes was sustained, a pattern distinct from bacterial sepsis or influenza. SARS-CoV-2 patient plasma inhibited HLA-DR expression, and this was partially restored by the IL-6 blocker Tocilizumab; off-label Tocilizumab treatment of patients was accompanied by increase in circulating lymphocytes. Thus, the unique pattern of immune dysregulation in severe COVID-19 is characterized by IL-6-mediated low HLA-DR expression and lymphopenia, associated with sustained cytokine production and hyper-inflammation.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.