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  • COVID‐19 bimodal clinical a...
    Batah, Sabrina S.; Benatti, Maíra N.; Siyuan, Li; Telini, Wagner M.; Barboza, Jamile O.; Menezes, Marcelo B.; Nadai, Tales R.; Sá, Keyla S. G.; Vaswani, Chirag M.; Gupta, Sahil; Zamboni, Dario S.; Wada, Danilo T.; Calado, Rodrigo T.; Oliveira, Renê D. R.; Louzada‐Junior, Paulo; Auxiliadora‐Martins, Maria; Veras, Flávio P.; Cunha, Larissa D.; Cunha, Thiago M.; Luppino‐Assad, Rodrigo; Balancin, Marcelo L.; Morais, Sirlei S.; Martins, Ronaldo B.; Arruda, Eurico; Chahud, Fernando; Santos, Marcel Koenigkam; Cetlin, Andrea A.; Cunha, Fernando Q.; dos Santos, Claudia; Capelozzi, Vera L.; Fukuoka, Junya; Achcar, Rosane Duarte; Fabro, Alexandre T.

    Clinical and translational medicine, January 2022, Letnik: 12, Številka: 1
    Journal Article

    According to other studies,6,7 these patients presented a progressive decline in PaO2/FiO2 ratio (Figure 1B) and low compliance levels during hospitalization (Supporting information Table S5), suggesting a poor clinical outcome. ...fibrotic phenotype patients showed neutrophil extracellular traps to a significantly greater extent throughout lung parenchyma compared to thrombotic phenotype patients (p = 0.0004) (Supporting information Figure S3), which is a crucial response during the acute COVID-19 phase and a potential contributory factor to later fibrotic phase by amplifying the chronic reparative phase.8 IMAGE OMITTED. ...sudden death occurred, probably due to higher frequency (80%) of pulmonary thromboembolism (Supporting information Table S6), equally described in other study.10 As expected, d-dimer levels and platelet counts were higher in these patients than in fibrotic phenotype subjects (Supporting information Figure S1A and B and Table S8). ...the longer disease progression could give histopathological basis for an organizing phase, with sustained myofibroblastic proliferation, interstitial scarring and parenchymal remodeling, representing the “birth” of fibrosis as a future and possible sequel in post-COVID-19 patients, called as the fibrotic phenotype; or gradual recovery of the acute/sub-acute lung injury associated with thrombosis and unexpected sudden death, called as thrombotic phenotype (Figures 1 and 3). ...we believe that the categorization of patients based on these two phenotypes can be used to develop prognostic tools and potential therapies since the PaO2/FiO2 ratio and d-dimer correlate with the underlying fibrotic or thrombotic pathophysiologic process, which may indicate the possible clinical outcome of the patient.