ArticleScientific reports2021
Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis.
Article in Scientific reports, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- Probiotics for preventing or treating COVID-19; a systematic review of research evidence and meta-analyses of efficacy for preventing death, severe disease, or disease progression.Wellcome open research · 2022Pooled it
- A randomized, double-blinded, placebo-controlled clinical trial of sterile filtered human amniotic fluid for treatment of COVID-19.BMC infectious diseases · 2023Trial
- Heterogeneity of Immunological, Coagulation and Complement Clustering to Viral Challenge and Clinical Relevance.International journal of molecular sciences · 2026Article
- Association Between Serum Ferritin and Disease Severity in COVID-19 Patients in Bangladesh: A Cross-Sectional Study.Cureus · 2026Article
- Interaction of HERVs with PAMPs in Dysregulation of Immune Response Cascade Upon SARS-CoV-2 Infections.International journal of molecular sciences · 2024Review
- The Saga of COVID-19 in Chronic Lung Disease: History Repeats Itself.Annals of the American Thoracic Society · 2024Article
- Clinical Outcomes of Coronavirus Disease 2019 in People Living With Human Immunodeficiency Virus in South Korea: A Nationwide Population-Based Cohort Study.Influenza and other respiratory viruses · 2024Article
- Trajectory clustering of immune cells and its association with clinical outcomes after aneurysmal subarachnoid hemorrhage.Frontiers in neurology · 2024Article
- SARS-CoV-2 awakens ancient retroviral genes and the expression of proinflammatory HERV-W envelope protein in COVID-19 patients.iScience · 2023Article
- Model-interpreted outcomes of artificial neural networks classifying immune biomarkers associated with severe infections in ICU.Frontiers in immunology · 2023Article
- Preadmission Statin Treatment and Outcome in Patients Hospitalized With COVID-19.The American journal of cardiology · 2022Article
- Applying Lessons Learned From COVID-19 Therapeutic Trials to Improve Future ALI/ARDS Trials.Open forum infectious diseases · 2022Review
- Current Therapeutics for COVID-19, What We Know about the Molecular Mechanism and Efficacy of Treatments for This Novel Virus.International journal of molecular sciences · 2022Review
- Cytokine profiles in the detection of severe lung involvement in hospitalized patients with COVID-19: The IL-8/IL-32 axis.Cytokine · 2022Article
- SARS-CoV-2 infection and coronavirus disease 2019 severity in persons with HIV on antiretroviral treatment.AIDS (London, England) · 2022Review
- HERV-W ENV antigenemia and correlation of increased anti-SARS-CoV-2 immunoglobulin levels with post-COVID-19 symptoms.Frontiers in immunology · 2022Article
- Evaluation of emerging inflammatory markers for predicting oxygen support requirement in COVID-19 patients.PloS one · 2022Article
- Plasma Proteome Fingerprints Reveal Distinctiveness and Clinical Outcome of SARS-CoV-2 Infection.Viruses · 2021Observational
- Predication of oxygen requirement in COVID-19 patients using dynamic change of inflammatory markers: CRP, hypertension, age, neutrophil and lymphocyte (CHANeL).Scientific reports · 2021Article
- Identification of Endotypes of Hospitalized COVID-19 Patients.Frontiers in medicine · 2021Article
Corrections and comments
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Authors and funding
12 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The objective of the study was to identify distinct patterns in inflammatory immune responses of COVID-19 patients and to investigate their association with clinical course and outcome. Data from hospitalized COVID-19 patients were retrieved from electronic medical record. Supervised k-means clustering of serial C-reactive protein levels (CRP), absolute neutrophil counts (ANC), and absolute lymphocyte counts (ALC) was used to assign immune responses to one of three groups. Then, relationships between patterns of inflammatory responses and clinical course and outcome of COVID-19 were assessed in a discovery and validation cohort. Unbiased clustering analysis grouped 105 patients of a discovery cohort into three distinct clusters. Cluster 1 (hyper-inflammatory immune response) was characterized by high CRP levels, high ANC, and low ALC, whereas Cluster 3 (hypo-inflammatory immune response) was associated with low CRP levels and normal ANC and ALC. Cluster 2 showed an intermediate pattern. All patients in Cluster 1 required oxygen support whilst 61% patients in Cluster 2 and no patient in Cluster 3 required supplementary oxygen. Two (13.3%) patients in Cluster 1 died, whereas no patient in Clusters 2 and 3 died. The results were confirmed in an independent validation cohort of 116 patients. We identified three different patterns of inflammatory immune response to COVID-19. Hyper-inflammatory immune responses with elevated CRP, neutrophilia, and lymphopenia are associated with a severe disease and a worse outcome. Therefore, targeting the hyper-inflammatory response might improve the clinical outcome of COVID-19.
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