Evidence map›Paper›PMID 33965003›Full record

ReviewThe Lancet. Respiratory medicine2021

The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity.

Marcin F Osuchowski, Martin S Winkler, Tomasz Skirecki, Sara Cajander, Manu Shankar-Hari, Gunnar Lachmann, Guillaume Monneret, Fabienne Venet, Michael Bauer, Frank M Brunkhorst and 24 more

Open access · bronzeAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in The Lancet. Respiratory medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 309 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
309citing papers in PubMed, 7 pooled it
36.4field-weighted citation impact, top 1% 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

309 citing papers in PubMed, 7 syntheses or guidelines pooled it, 571 citations in OpenAlex.

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  7. Recent Advance Analysis of Recovery in Hospitalized People with COVID-19: A Systematic Review.International journal of environmental research and public health · 2022
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249 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

34 authors at 20 institutions in 13 countries.

Marcin F OsuchowskiLudwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria.
Martin S WinklerDepartment of Anaesthesiology, University of Göttingen Medical Center, Göttingen, Georg-August University of Göttingen, Göttingen, Germany.
Tomasz SkireckiLaboratory of Flow Cytometry, Centre of Postgraduate Medical Education, Warsaw, Poland.
Sara CajanderDepartment of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Manu Shankar-HariGuy's and St Thomas' NHS Foundation Trust, ICU support offices, St Thomas' Hospital, London, UK; School of Immunology & Microbial Sciences, Kings College London, London, UK.
Gunnar LachmannDepartment of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
Guillaume MonneretHospices Civils de Lyon, Immunology Laboratory, Edouard Herriot Hospital, Lyon, France; Pathophysiology of Injury-Induced Immunosuppression, Equipe d'Accueil 7426, Université Claude Bernard Lyon 1 - bioMérieux - Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
Fabienne VenetHospices Civils de Lyon, Immunology Laboratory, Edouard Herriot Hospital, Lyon, France; Pathophysiology of Injury-Induced Immunosuppression, Equipe d'Accueil 7426, Université Claude Bernard Lyon 1 - bioMérieux - Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
Michael BauerDepartment of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital-Friedrich Schiller University, Jena, Germany.
Frank M BrunkhorstDepartment of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital-Friedrich Schiller University, Jena, Germany; Center for Clinical Studies, Jena University Hospital-Friedrich Schiller University, Jena, Germany.
Sebastian WeisDepartment of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital-Friedrich Schiller University, Jena, Germany; Institute for Infectious Disease and Infection Control, Jena University Hospital-Friedrich Schiller University, Jena, Germany.
Alberto Garcia-SalidoPediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Matthijs KoxDepartment of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands.
Jean-Marc CavaillonAgence Nationale de la Recherche, Paris, France.
Florian UhleDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
Markus A WeigandDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
Stefanie B FlohéDepartment of Trauma, Hand, and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
W Joost WiersingaDivision of Infectious Diseases and Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Raquel AlmansaGroup for Biomedical Research in Sepsis, Hospital Universitario Río Hortega de Valladolid, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Instituto de salud Carlos III, Madrid, Spain.
Amanda de la FuenteGroup for Biomedical Research in Sepsis, Hospital Universitario Río Hortega de Valladolid, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain.
Ignacio Martin-LoechesMultidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland.
Christian MeiselInstitute for Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology, Labor Berlin-Charité Vivantes, Berlin, Germany.
Thibaud SpinettiDepartment of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Joerg C SchefoldDepartment of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Catia CillonizPneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, ICREA, CIBERESUCICOVID, Spain.
Antoni TorresDivision of Infectious Diseases and Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, ICREA, CIBERESUCICOVID, Spain; SGR 911-ICREA Academia, Barcelona, Spain.
Evangelos J Giamarellos-Bourboulis4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Ricard FerrerCentro de Investigación Biomedica En Red-Enfermedades Respiratorias, Instituto de salud Carlos III, Madrid, Spain; Intensive Care Department and Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Massimo GirardisDepartment of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
Andrea CossarizzaDepartment of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
Mihai G NeteaDepartment of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands; Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, Romania; Department for Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany.
Tom van der PollDivision of Infectious Diseases and Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Jesús F Bermejo-MartínGroup for Biomedical Research in Sepsis, Hospital Universitario Río Hortega de Valladolid, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Instituto de salud Carlos III, Madrid, Spain.
Ignacio RubioDepartment of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital-Friedrich Schiller University, Jena, Germany. Electronic address: ignacio.rubio@med.uni-jena.de.
Friedrich Schiller University Jena · DECentro de Investigación Biomédica en Red de Enfermedades Respiratorias · ESHeidelberg University · DEHospital Universitario Río Hortega · ESUniversitat de Barcelona · ESUniversity of Bern · CHUniversity of Modena and Reggio Emilia · ITAcademic Medical Center · NLAgence Nationale de la Recherche · FRAmsterdam University Medical Centers · NLBerlin Institute of Health at Charité - Universitätsmedizin Berlin · DEbioMérieux (France) · FRCharité - Universitätsmedizin Berlin · DEHospital Infantil Universitario Niño Jesús · ESKing's College London · GBLudwig Boltzmann Institute for Experimental and Clinical Traumatology · ATNational and Kapodistrian University of Athens · GRÖrebro University · SEPostgraduate School of Molecular Medicine · PLRadboud University Medical Center · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The zoonotic SARS-CoV-2 virus that causes COVID-19 continues to spread worldwide, with devastating consequences. While the medical community has gained insight into the epidemiology of COVID-19, important questions remain about the clinical complexities and underlying mechanisms of disease phenotypes. Severe COVID-19 most commonly involves respiratory manifestations, although other systems are also affected, and acute disease is often followed by protracted complications. Such complex manifestations suggest that SARS-CoV-2 dysregulates the host response, triggering wide-ranging immuno-inflammatory, thrombotic, and parenchymal derangements. We review the intricacies of COVID-19 pathophysiology, its various phenotypes, and the anti-SARS-CoV-2 host response at the humoral and cellular levels. Some similarities exist between COVID-19 and respiratory failure of other origins, but evidence for many distinctive mechanistic features indicates that COVID-19 constitutes a new disease entity, with emerging data suggesting involvement of an endotheliopathy-centred pathophysiology. Further research, combining basic and clinical studies, is needed to advance understanding of pathophysiological mechanisms and to characterise immuno-inflammatory derangements across the range of phenotypes to enable optimum care for patients with COVID-19.

Indexed as

COVID-19Multiple Organ FailureEndotheliumHumansImmunityPatient AcuitySARS-CoV-2Severity of Illness Index

Identifiers

PMID33965003
PMCPMC8102044
OpenAlexW3162905796

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.