Factors to consider when assessing the severity of COVID-19

Abstract

Background: Analysis and evaluation of the multitude of parameters that impact and mirror clinical evolution of COVID-19 infection. Narrative literature review type of study. Bibliographic search of the PubMed database, applying the keywords: ”SARS-CoV-2”, ”COVID-19”, ”risk score”, ”laboratory parameters”, ”pathophysiology”, ”cytokine storm”, ”imaging evaluation”, “outcomes”, “clinical evolution”, which were combined with each other. There were selected English-language publications, in extenso, published in recognized journals from March 2020. Priority in the analysis was given to articles of critical synthesis of literature, randomized studies, those with large samples of patients. One of the clinically important symptoms that reflects severe or critical clinical evolution is persistent fever during the time. The presence of comorbidities, especially associated with obesity, represents a high risk of severe evolution. Proinflammatory, prothrombotic and systemic endothelial damage processes are represented by changes in platelet count, lymphocytes, neutrophil / lymphocyte ratio, C-reactive protein, D-dimers, fibrinogen, procalcitonin, urea, creatinine, ALS, AST, interleukin-6 and serum ferritin. Bacterial and fungal infections negatively influence clinical evolution. Common prediction scores have low value in COVID-19 patients and need adaptation. Imaging evaluation identifies the type of lung injury and correlates with the severity degree and outcome. Conclusions: COVID-19 disease caused by SARS-CoV-2 virus includes a multitude of pathophysiological changes that through its mechanism represent a systemic nosology. The complete analysis of all the factors and parameters that can influence its clinical evolution is a basic component of the decisionmaking steps and treatment approach.