Risk Stratification

Individuals diagnosed with COVID-19 should undergo assessment to estimate progression to severe disease. Risk assessment may inform the need for additional testing and guide treatment, including establishing eligibility for clinical trials. Many risk factors for severe disease have been identified from observational data, although most are non-specific and can occur separately from COVID-19 disease (Zhou, et al., Lancet, 2020). UPHS has identified several risk factors that may be associated with increased risk. Any single risk factor below may confer increased risk of progression to severe disease:

• Epidemiologic: Age >55, pre-existing pulmonary disease, chronic kidney disease, diabetes, history of hypertension, history of cardiovascular disease, use of immunosuppression/biologic medications, uncontrolled HIV (CD4 < 200), history of organ transplant, actively treated malignancy, BMI > 40
• Vital Signs: Respiratory rate >24 breaths/minute, heart rate >125 beats/minute, SpO2 < 90% on room air
• Labs: D-dimer >1000ng/ml, CPK >2x upper limit of normal, non-cardiac CRP >100, LDH >245 U/L, elevated troponin, admission absolute lymphocyte count < 0.8, ferritin >300 ug/L (>800 ug/L associated with increased risk of mortality), higher SOFA Score

See Cardiovascular Testing Considerations for recommendations regarding indications and frequency of cardiology-specific testing