Table 2.
Summary of severity
| Summary of the definitions for severity of 2019-CoV in two guidelines | ||||
|---|---|---|---|---|
| Severity category in WHO guideline | Definition for adults in WHO guideline | WHO definition for children | Severity category in the Chinese 4th edition guideline | Definition in the Chinese 4th edition guideline |
| Mild | Patient with pneumonia and no signs of severe pneumonia | Child with non-severe pneumonia has cough or difficulty breathing + fast breathing: fast breathing (in breaths/min): < 2 months, ≥ 60; 2–11 months, ≥ 50; 1–5 years, ≥ 40 and no signs of severe pneumonia | Mild | Patient can present as common symptoms: fever, dry cough, fatigue, headache, sore throat |
| Severe | Adolescent or adult: fever or suspected respiratory infection, plus one of respiratory rate > 30 breaths/min, severe respiratory distress, or SpO2 < 90% on room air |
Child with cough or difficulty in breathing, plus at least one of the following: 1. Central cyanosis or SpO2 < 90% 2. Severe respiratory distress 3. Signs of pneumonia with a general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions 4. Other signs of pneumonia may be present: chest in-drawing, fast breathing (in breaths/min): < 2 months, ≥ 60 2–11 months, ≥ 50 1–5 years, ≥ 40 |
Severe |
Patient who fits any one of the following condition: 1. Respiratory rate ≥ 30 breath/min 2. SpO2 ≤ 93% 3. PaO2/FiO2 ≤ 300 mmHg (1 mmHg = 0.133 kPa) |
| Acute respiratory distress |
1. Onset: new or worsening respiratory symptoms within one week of known clinical insult 2. Chest imaging (radiograph, CT scan, or lung ultrasound): bilateral opacities, not fully explained by effusions, lobar or lung collapse, or nodules 3. Origin of oedema: respiratory failure not fully explained by cardiac failure or fluid overload. Need objective assessment (e.g. echocardiography) to exclude hydrostatic cause of oedema if no risk factor present 4. Oxygenation Mild ARDS: 200 mmHg < PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥ 5 cmH2O, or non-ventilated) Moderate ARDS: 100 mmHg < PaO2/FiO2 ≤ 200 mmHg with PEEP ≥ 5 cmH2O, or non-ventilated) Severe ARDS: PaO2/FiO2 ≤ 100 mmHg with PEEP ≥ 5 cmH2O, or non-ventilated) When PaO2 is not available, SpO2/FiO2 ≤ 315 suggests ARDS (including in non-ventilated patients) |
1. Child has the same symptoms as adults’ (left 1–3) 2. Bilevel NIV or CPAP ≥ 5 cmH2O via full face mask: PaO2/FiO2 ≤ 300 mmHg or SpO2/FiO2 ≤ 264 Mild ARDS (invasively ventilated): 4 ≤ OI < 8 or 5 ≤ OSI < 7.5 Moderate ARDS (invasively ventilated): 8 ≤ OI < 16 or 7.5 ≤ OSI < 12.3 Severe ARDS (invasively ventilated): OI ≥ 16 or OSI ≥ 12.3 |
Life-threatening |
Patient fits any of the following conditions: 1. Patient presents respiratory distress and needs mechanical ventilation support 2. Patient presents shock 3. Patient presents MODS and needs ICU admission |
| Sepsis |
Life-threatening organ dysfunction caused by a dysregulated host response to suspected or proven infection, with organ dysfunction Signs of organ dysfunction include: 1. Altered mental status 2. Difficult or fast breathing 3. Low oxygen saturation, reducedurine output 4. Fast heart rate, weak pulse 5. Cold extremities or low blood pressure, skin mottling 6. Or laboratory evidence of coagulopathy, thrombocytopenia, acidosis, high lactate or hyperbilirubinemia |
Children: suspected or proven infection and ≥ 2 SIRS criteria, of which one must be abnormal temperature or white blood cell count | ||
| Septic shock | Patient persists hypotension despite volume resuscitation, requires vasopressors to maintain MAP ≥ 65 mmHg and serum lactate level > 2 mmol/L |
Patients presents any hypotension (SBP < 5th centile or > 2 SD below normal for age) or 2–3 of the following: 1. Altered mental state 2. Tachycardia or bradycardia (HR < 90 bpm or > 160 bpm in infants and HR < 70 bpm or > 150 bpm in children) 3. Prolonged capillary refill (> 2 s) or warm vasodilation with bounding pulses; tachypnea 4. Mottled skin or petechial or purpuric rash; increased lactate 5. Oliguria; hyperthermia or hypothermia |
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ARI acute respiratory infection, BP blood pressure, bpm beats/minute, CPAP continuous positive airway pressure, FiO2 fraction of inspired oxygen, MAP mean arterial pressure, NIV non-invasive ventilation, SBP systolic blood pressure, SD standard deviation, SIRS systemic inflammatory response syndrome, SpO2 oxygen saturation, ARDS acute respiratory distress syndrome, HR heart rate, PaO2 partial press of oxygen, SBP systolic blood pressure, ICU intensive-care unit, MODS multiple organ dysfunction syndrome, OI Oxygenation Index, OSI Oxygenation Index