Evidence map›Paper›PMID 34090021›Full record

ArticleJournal of the neurological sciences2021

Cerebrospinal fluid in COVID-19 neurological complications: Neuroaxonal damage, anti-SARS-Cov2 antibodies but no evidence of cytokine storm.

Maria A Garcia, Paula V Barreras, Allie Lewis, Gabriel Pinilla, Lori J Sokoll, Thomas Kickler, Heba Mostafa, Mario Caturegli, Abhay Moghekar, Kathryn C Fitzgerald and 2 more

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

Article in Journal of the neurological sciences, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
48citing papers in PubMed, 5 pooled it
6.9field-weighted citation impact, top 2% 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

48 citing papers in PubMed, 5 syntheses or guidelines pooled it, 67 citations in OpenAlex.

  1. Pooled it
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  11. [Subtle and subclinical neurological findings in patients with SARS-CoV-2].Revista medica del Instituto Mexicano del Seguro Social · 2023
    Observational
  12. Article
  13. Article
  14. Review
  15. Article
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  20. Citicoline and COVID-19: vis-à-vis conjectured.Naunyn-Schmiedeberg's archives of pharmacology · 2022
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 3 institutions in 2 countries.

Maria A GarciaDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Paula V BarrerasDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Allie LewisDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Gabriel PinillaFundacion Valle de Lili, Cali, Colombia.
Lori J SokollDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Thomas KicklerDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Heba MostafaDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Mario CaturegliDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Abhay MoghekarDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Kathryn C FitzgeraldDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Hopkins Neuro-COVID-19 Group
Carlos A PardoDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America. Electronic address: cpardov1@jhmi.edu.
Johns Hopkins University · USJohns Hopkins Medicine · USFundación Valle del Lili · CO

Funding

Emerging Neuroviruses and Neurological Inflammatory DiseasesR01NS110122 · NINDS · JOHNS HOPKINS UNIVERSITY · PI PARDO-VILLAMIZAR, CARLOS A · 2019 to 2023
$1.7M
Circadian Rhythms and Sleep, Structural Neuroimaging and Depression in People with Multiple SclerosisK01MH121582 · NIMH · JOHNS HOPKINS UNIVERSITY · PI FITZGERALD, KATHRYN C. · 2019 to 2022
$675k
NIMH NIH HHS K01 MH121582NINDS NIH HHS R01 NS110122
6 · The paper itself

Abstract

objectiveTo study in cerebrospinal fluid (CSF) of COVID-19 subjects if a "cytokine storm" or neuroinflammation are implicated in pathogenesis of neurological complications.

methodsCross-sectional study of CSF neuroinflammatory profiles from 18 COVID-19 subjects with neurological complications categorized by diagnosis (stroke, encephalopathy, headache) and illness severity. COVID-19 CSF was compared with CSF from healthy, infectious and neuroinflammatory disorders and stroke controls (n = 82). Cytokines (IL-6, TNFα, IFNγ, IL-10, IL-12p70, IL-17A), inflammation and coagulation markers (high-sensitivity-C Reactive Protein [hsCRP], ferritin, fibrinogen, D-dimer, Factor VIII) and neurofilament light chain (NF-L), were quantified. SARS-CoV2 RNA and SARS-CoV2 IgG and IgA antibodies in CSF were tested with RT-PCR and ELISA.

resultsCSF from COVID-19 subjects showed absence of pleocytosis or specific increases in pro-inflammatory markers (IL-6, ferritin, or D-dimer). Although pro-inflammatory cytokines (IL-6, TNFα, IL-12p70) and IL-10 were increased in CSF of stroke COVID-19 subjects, a similar increase was observed in non-COVID-19 stroke subjects. Anti-SARS-CoV2 antibodies in CSF of COVID-19 subjects (77%) were observed despite no evidence of SARS-CoV2 viral RNA. CSF-NF-L was elevated in subjects with stroke and critical COVID-19 as compared to controls and other COVID-19 severity categories. CSF-hsCRP was present in all subjects with critical stages of COVID-19 (7/18) but only in 1/82 controls.

conclusionThe paucity of neuroinflammatory changes in CSF of COVID-19 subjects and lack of SARS-CoV2 RNA do not support the presumed neurovirulence of SARS-CoV2 or neuroinflammation in pathogenesis of neurological complications in COVID-19. The role of CSF SARS-CoV2 IgG antibodies and mechanisms of neuronal damage are still undetermined.

Indexed as

COVID-19Cytokine Release SyndromeCross-Sectional StudiesCytokinesHumansRNA, ViralSARS-CoV-2CytokinesRNA, ViralCerebrospinal fluidCOVID-19CytokinesCytokine stormNeuroinflammation

Identifiers

PMID34090021
PMCPMC8166041
OpenAlexW3168524889

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.