Evidence map›Paper›PMID 33058143›Full record

SynthesisEuropean journal of clinical investigation2021

Deciphering the COVID-19 cytokine storm: Systematic review and meta-analysis.

Rubina Mulchandani, Tanica Lyngdoh, Ashish Kumar Kakkar

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European journal of clinical investigation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 152 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
152citing papers in PubMed, 11 pooled it
5.0field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

152 citing papers in PubMed, 11 syntheses or guidelines pooled it, 242 citations in OpenAlex.

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  4. Overlapping cytokines inFrontiers in immunology · 2023
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  18. Frontiers in immunology · 2026
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92 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 1 country.

Rubina MulchandaniIndian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India.ORCID https://orcid.org/0000-0001-7330-9285
Tanica LyngdohIndian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India.
Ashish Kumar KakkarPostgraduate Institute of Medical Education and Research, Chandigarh, India.ORCID https://orcid.org/0000-0001-7768-7304
Institute of Public Health Bengaluru · INPost Graduate Institute of Medical Education and Research · IN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe coronavirus pandemic has affected more than 20 million people so far. Elevated cytokines and suppressed immune responses have been hypothesized to set off a cytokine storm, contributing to ARDS, multiple-organ failure and, in the most severe cases, death. We aimed to quantify the differences in the circulating levels of major inflammatory and immunological markers between severe and nonsevere COVID-19 patients.

methodsRelevant studies were identified from PubMed, EMBASE, Web of Science, SCOPUS and preprint servers. Risk of bias was assessed for each study, using appropriate checklists. All studies were described qualitatively and a subset was included in the meta-analysis, using forest plots.

resultsBased on 23 studies, mean cytokine levels were significantly higher (IL-6: MD, 19.55 pg/mL; CI, 14.80, 24.30; IL-8: MD, 19.18 pg/mL; CI, 2.94, 35.43; IL-10: MD, 3.66 pg/mL; CI, 2.41, 4.92; IL-2R: MD, 521.36 U/mL; CI, 87.15, 955.57; and TNF-alpha: MD, 1.11 pg/mL; CI, 0.07, 2.15) and T-lymphocyte levels were significantly lower (CD4+ T cells: MD, -165.28 cells/µL; CI, -207.58, -122.97; CD8+ T cells: MD, -106.51 cells/µL; CI, -128.59, -84.43) among severe cases as compared to nonsevere ones. There was heterogeneity across studies due to small sample sizes and nonuniformity in outcome assessment and varied definitions of disease severity. The overall quality of studies was sub-optimal.

conclusionSevere COVID-19 is characterized by significantly increased levels of pro-inflammatory cytokines and reduced T lymphocytes. Well-designed and adequately powered prospective studies are needed to amplify the current evidence and provide definitive answers to dilemmas regarding timing and type of anti-COVID-19 therapy particularly in severe patients.

Indexed as

CD4 Lymphocyte CountCD4-Positive T-LymphocytesCD8-Positive T-LymphocytesCOVID-19Cytokine Release SyndromeCytokinesHumansInterleukin-10Interleukin-6Interleukin-8Lymphocyte CountReceptors, Interleukin-2SARS-CoV-2Severity of Illness IndexTumor Necrosis Factor-alphaCytokinesInterleukin-10Interleukin-6Interleukin-8Receptors, Interleukin-2Tumor Necrosis Factor-alphaCD4+ T cellsCD8+ T cellsCOVID-19cytokine stormnovel coronavirusSARS-CoV-2

Identifiers

PMID33058143
PMCPMC7646004
OpenAlexW3093211696

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.