Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 27;11(1):2045894020988630.
doi: 10.1177/2045894020988630. eCollection 2021 Jan-Mar.

Clinical risk stratification in COVID-19: the need for a revised approach?

Robin Cherian  1
Affiliations

Clinical risk stratification in COVID-19: the need for a revised approach?

Robin Cherian. Pulm Circ. .
No abstract available

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Clinicopathological discordance in COVID-19 and options for risk stratification at various stages of the disease progression. In pneumonia, there is concordance between pathological progression and symptoms/signs of respiratory failure, as the dominant pathology is alveolar exudate and the dominant mechanism of hypoxemia is alveolar hypoventilation/shunting and venous admixing. This facilitates early clinical risk stratification based on symptoms (dyspnea), arterial oxygen saturation, and radiological features. However, in COVID-19, due to the dominant pathophysiological role of pulmonary vascular occlusion in disease progression and abnormal gas exchange, there is discordance between the extent of pathology and respiratory failure severity. Distinct features include silent hypoxemia and rapidly progressing respiratory failure from the onset of hypoxemia and dyspnea. An alternate approach to risk stratification, that employs endothelial and thrombotic biomarkers, tests of global hemostasis, perfusion imaging, and dynamic measures of perfusion adequacy such as exercise oximetry may help identify pathological progression early and guide interventions. Early and appropriate antithrombotic strategy based on pathological severity may alter the natural history of the disease with improvement in outcomes.
See this image and copyright information in PMC

References

    1. Nicolai L, Leunig A, Brambs S, et al. Immunothrombotic dysregulation in COVID-19 pneumonia is associated with respiratory failure and coagulopathy. Circulation 2020; 142: 1176–1189. - PMC - PubMed
    1. McFadyen JD, Stevens H, Peter K. The emerging threat of (micro)thrombosis in COVID-19 and its therapeutic implications. Circ Res 2020; 127: 571–587. - PMC - PubMed
    1. Low T-T, Cherian R, Lim SL, et al. Rethinking COVID-19 ‘pneumonia’ – is this primarily a vaso-occlusive disease, and can early anticoagulation save the ventilator famine? Pulm Circ 2020; 10: 204589402093170. - PMC - PubMed
    1. Patel BV, Arachchillage DJ, Ridge CA, et al. Pulmonary angiopathy in severe COVID-19: physiologic, imaging and hematologic observations. Am J Respir Crit Care Med 2020; 202: 690–699. - PMC - PubMed
    1. Beenen LFM, Bos LD, Scheerder MJ, et al. Extensive pulmonary perfusion defects compatible with microthrombosis and thromboembolic disease in severe Covid-19 pneumonia. Thromb Res 2020; 196: 135–137. - PMC - PubMed

LinkOut - more resources