Centro de Investigación Biomedica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
CRIPS, Vall d'Hebron Institute of Research, Barcelona, Spain.
Eur Respir J. 2020 May 21;55(5). doi: 10.1183/13993003.01028-2020. Print 2020 May.
Patients with COVID-19 present a broad spectrum of clinical presentation. Whereas hypoxaemia is the marker of severity, different strategies of management should be customised to five specific individual phenotypes. Many intubated patients present with phenotype 4, characterised by pulmonary hypoxic vasoconstriction, being associated with severe hypoxaemia with "normal" (>40 mL·cmHO) lung compliance and likely representing pulmonary microvascular thrombosis. Phenotype 5 is often associated with high plasma procalcitonin and has low pulmonary compliance, Which is a result of co-infection or acute lung injury after noninvasive ventilation. Identifying these clinical phenotypes and applying a personalised approach would benefit the optimisation of therapies and improve outcomes.
COVID-19 患者表现出广泛的临床症状。虽然低氧血症是严重程度的标志，但应根据五种特定的个体表型来定制不同的治疗策略。许多需要插管的患者表现出表型 4，其特征是肺缺氧性血管收缩，与严重低氧血症相关（“正常”>40 mL·cmH2O），肺顺应性和可能代表肺微血管血栓形成。表型 5 常与高血浆降钙素原相关，肺顺应性低，这是继发于合并感染或无创通气后急性肺损伤。确定这些临床表型并采用个性化方法将有利于优化治疗并改善结局。
