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The perils of premature phenotyping in COVID-19: a call for caution

Lieuwe D.J. Bos, Pratik Sinha, Robert P. Dickson
European Respiratory Journal 2020 56: 2001768; DOI: 10.1183/13993003.01768-2020
Lieuwe D.J. Bos
1Intensive Care, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Infection and Immunity, Amsterdam, The Netherlands
2Dept of Respiratory Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Infection and Immunity, Amsterdam, The Netherlands
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  • For correspondence: l.d.bos@amsterdamumc.nl
Pratik Sinha
3Dept of Medicine, University of California, San Francisco San Francisco, CA, USA
4Dept of Anesthesia, University of California, San Francisco San Francisco, CA, USA
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Robert P. Dickson
5Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
6Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
7Michigan Center for Integrative Research in Critical Care, Ann Arbor, MI, USA
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Extract

The severe acute respiratory syndrome coronavirus 2 poses an unprecedented global healthcare challenge. Severe coronavirus disease 2019 (COVID-19) pneumonia frequently causes hypoxaemic respiratory failure, manifesting in the acute respiratory distress syndrome (ARDS). Recently, authors have proposed distinct clinical phenotypes of COVID-19 pneumonia in several influential, high-profile essays [1–3]. For example, in a recent perspective in this journal [3], the authors speculated that COVID-19 has five phenotypic presentations: three phenotypes based on severity of hypoxaemia and need for supportive care (no hypoxaemia, mild hypoxaemia, and moderate hypoxaemia), and two phenotypes of severely hypoxaemic patients based on additional physiological and clinical features.

Abstract

By prematurely phenotyping patients with COVID-19, we and our patients are exposed to considerable and preventable risk. If data-driven phenotypes are not insisted upon, our cognitive biases guarantee that we'll end up with phenotype-driven data. https://bit.ly/2ZM8wZV

Footnotes

  • Conflict of interest: L.D.J. Bos reports grants from the Dutch lung foundation (young investigator grant), the Dutch lung foundation (public-private partnership grant), the Dutch Lung Foundation (Dirkje Postma Award), personal fees from Bayer (for consultancy), outside the submitted work.

  • Conflict of interest: P. Sinha has nothing to disclose.

  • Conflict of interest: R.P. Dickson has nothing to disclose.

  • Received May 13, 2020.
  • Accepted May 23, 2020.
  • Copyright ©ERS 2020
http://creativecommons.org/licenses/by-nc/4.0/

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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The perils of premature phenotyping in COVID-19: a call for caution
Lieuwe D.J. Bos, Pratik Sinha, Robert P. Dickson
European Respiratory Journal Jul 2020, 56 (1) 2001768; DOI: 10.1183/13993003.01768-2020

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The perils of premature phenotyping in COVID-19: a call for caution
Lieuwe D.J. Bos, Pratik Sinha, Robert P. Dickson
European Respiratory Journal Jul 2020, 56 (1) 2001768; DOI: 10.1183/13993003.01768-2020
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