Since its first description, SARS-CoV-2 has been the subject of more than 59 000 publications worldwide. Although SARS-CoV-2 infection mainly results in mild disease, during the first COVID-19 wave in France, up to 3% of patients required admission to hospital, 0·8% required intensive care unit admission, and overall mortality was reported to be around 0·5%. The ability to predict disease severity and subsequent course might help with triaging patients, optimising resource management, and understanding modifiable and non-modifiable factors involved in patient outcomes.
In The Lancet Infectious Diseases, Belén Gutiérrez-Gutiérrez and colleagues aimed to identify clinical phenotypes of COVID-19 among patients who required admission to hospital. In this large, multicentre, retrospective cohort study, the authors report the outcomes of 4035 patients with COVID-19 admitted to 127 Spanish hospitals between Feb 2 and March 17, 2020. The authors did a two-step cluster analysis to identify clinical characteristics associated with patient outcomes, and identified three phenotypes with adequate performance in predicting 30-day patient mortality in derivation, internal validation, and external validation cohorts.
Despite these limitations, this study asks important questions concerning the management of patients with COVID-19. Identification of these three phenotypes could be an important step to anticipate patient clinical course during an era in which physicians and health systems around the world are facing a new surge and emergence of new SARS-CoV-2 variants. Establishing whether these identified phenotypes could be helpful in clinical practice and how they could help us promote adequate management strategies in a rapidly changing epidemic will undoubtedly be the next important step.