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LitCovid-PubTator

Id Subject Object Predicate Lexical cue tao:has_database_id
1 47-71 Disease denotes coronavirus disease 2019 MESH:C000657245
8 73-120 Species denotes Severe acute respiratory syndrome coronavirus-2 Tax:2697049
9 122-132 Species denotes SARS-CoV-2 Tax:2697049
10 161-185 Disease denotes coronavirus disease 2019 MESH:C000657245
11 187-195 Disease denotes COVID-19 MESH:C000657245
12 290-298 Disease denotes COVID-19 MESH:C000657245
13 339-344 Disease denotes death MESH:D003643
30 936-944 Species denotes patients Tax:9606
31 575-583 Disease denotes COVID-19 MESH:C000657245
32 619-638 Disease denotes respiratory failure MESH:D012131
33 795-817 Disease denotes venous thromboembolism MESH:D054556
34 819-822 Disease denotes VTE MESH:D054556
35 886-894 Disease denotes COVID-19 MESH:C000657245
36 1224-1228 Disease denotes VTEs
37 1269-1274 Disease denotes death MESH:D003643
38 1297-1301 Disease denotes VTEs
39 1329-1361 Disease denotes subsegmental pulmonary embolisms MESH:D011655
40 1388-1397 Disease denotes mortality MESH:D003643
41 1452-1455 Disease denotes VTE MESH:D054556
42 1487-1490 Disease denotes VTE MESH:D054556
43 1612-1620 Disease denotes COVID-19 MESH:C000657245
44 1652-1660 Disease denotes bleeding MESH:D006470
45 1720-1728 Disease denotes COVID-19 MESH:C000657245
48 1841-1850 Disease denotes mortality MESH:D003643
49 1884-1892 Disease denotes COVID-19 MESH:C000657245
60 2183-2195 Species denotes participants Tax:9606
61 2826-2834 Species denotes patients Tax:9606
62 2893-2901 Species denotes patients Tax:9606
63 2054-2056 Chemical denotes AC
64 2256-2261 Disease denotes death MESH:D003643
65 2301-2310 Disease denotes mortality MESH:D003643
66 2361-2370 Disease denotes mortality MESH:D003643
67 2503-2512 Disease denotes mortality MESH:D003643
68 2922-2927 Disease denotes death MESH:D003643
69 3119-3124 Disease denotes death MESH:D003643
86 4092-4100 Species denotes patients Tax:9606
87 4206-4214 Species denotes patients Tax:9606
88 4262-4270 Species denotes patients Tax:9606
89 3263-3273 Chemical denotes enoxaparin MESH:D017984
90 3746-3748 Chemical denotes AC
91 3300-3309 Disease denotes mortality MESH:D003643
92 3354-3362 Disease denotes COVID-19 MESH:C000657245
93 3544-3553 Disease denotes mortality MESH:D003643
94 3608-3614 Disease denotes sepsis MESH:D018805
95 3623-3635 Disease denotes coagulopathy MESH:D001778
96 3691-3700 Disease denotes mortality MESH:D003643
97 3936-3939 Disease denotes VTE MESH:D054556
98 3951-3959 Disease denotes bleeding MESH:D006470
99 4197-4205 Disease denotes COVID-19 MESH:C000657245
100 4295-4301 Disease denotes sepsis MESH:D018805
101 4310-4322 Disease denotes coagulopathy MESH:D001778
107 4609-4616 Chemical denotes heparin MESH:D006493
108 4404-4426 Disease denotes deep venous thrombosis MESH:D020246
109 4462-4470 Disease denotes COVID-19 MESH:C000657245
110 4555-4572 Disease denotes pulmonary thrombi MESH:D008171
111 4585-4593 Disease denotes embolism MESH:D004617
126 4965-4973 Species denotes patients Tax:9606
127 5278-5286 Species denotes patients Tax:9606
128 4657-4664 Chemical denotes Heparin MESH:D006493
129 4701-4708 Chemical denotes heparin MESH:D006493
130 4868-4875 Chemical denotes heparin MESH:D006493
131 4877-4881 Chemical denotes LMWH MESH:D006495
132 5211-5215 Chemical denotes LMWH MESH:D006495
133 4730-4739 Disease denotes infection MESH:D007239
134 5048-5066 Disease denotes pulmonary embolism MESH:D011655
135 5124-5132 Disease denotes bleeding MESH:D006470
136 5248-5253 Disease denotes death MESH:D003643
137 5315-5324 Disease denotes infection MESH:D007239
138 5519-5522 Disease denotes VTE MESH:D054556
139 5526-5531 Disease denotes death MESH:D003643
151 5960-5968 Species denotes patients Tax:9606
152 6094-6102 Species denotes patients Tax:9606
153 5948-5952 Chemical denotes LMWH MESH:D006495
154 6072-6076 Chemical denotes LMWH MESH:D006495
155 5589-5597 Disease denotes COVID-19 MESH:C000657245
156 5729-5732 Disease denotes VTE MESH:D054556
157 5778-5786 Disease denotes COVID-19 MESH:C000657245
158 5807-5810 Disease denotes VTE MESH:D054556
159 5873-5883 Disease denotes Thrombosis MESH:D013927
160 5987-5995 Disease denotes COVID-19 MESH:C000657245
161 6116-6119 Disease denotes VTE MESH:D054556
174 7065-7073 Species denotes patients Tax:9606
175 6184-6192 Disease denotes COVID-19 MESH:C000657245
176 6545-6548 Disease denotes VTE MESH:D054556
177 6553-6561 Disease denotes bleeding MESH:D006470
178 6589-6597 Disease denotes COVID-19 MESH:C000657245
179 6681-6684 Disease denotes VTE MESH:D054556
180 6689-6697 Disease denotes bleeding MESH:D006470
181 6756-6761 Disease denotes COVID MESH:C000657245
182 6897-6905 Disease denotes COVID-19 MESH:C000657245
183 6972-6975 Disease denotes VTE MESH:D054556
184 6983-6991 Disease denotes bleeding MESH:D006470
185 7003-7008 Disease denotes death MESH:D003643
190 7356-7359 Gene denotes MDP Gene:1800
191 7497-7500 Gene denotes MDP Gene:1800
192 7484-7487 Gene denotes MDP Gene:1800
193 7438-7441 Gene denotes MDP Gene:1800

LitCovid-PD-FMA-UBERON

Id Subject Object Predicate Lexical cue fma_id
T1 4609-4616 Body_part denotes heparin http://purl.org/sig/ont/fma/fma82839
T2 4657-4664 Body_part denotes Heparin http://purl.org/sig/ont/fma/fma82839
T3 4701-4708 Body_part denotes heparin http://purl.org/sig/ont/fma/fma82839
T4 4868-4875 Body_part denotes heparin http://purl.org/sig/ont/fma/fma82839

LitCovid-PD-MONDO

Id Subject Object Predicate Lexical cue mondo_id
T1 47-71 Disease denotes coronavirus disease 2019 http://purl.obolibrary.org/obo/MONDO_0100096
T2 73-120 Disease denotes Severe acute respiratory syndrome coronavirus-2 http://purl.obolibrary.org/obo/MONDO_0100096
T3 73-106 Disease denotes Severe acute respiratory syndrome http://purl.obolibrary.org/obo/MONDO_0005091
T4 122-130 Disease denotes SARS-CoV http://purl.obolibrary.org/obo/MONDO_0005091
T5 161-185 Disease denotes coronavirus disease 2019 http://purl.obolibrary.org/obo/MONDO_0100096
T6 187-195 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T7 290-298 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T8 575-583 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T9 619-638 Disease denotes respiratory failure http://purl.obolibrary.org/obo/MONDO_0021113
T10 795-817 Disease denotes venous thromboembolism http://purl.obolibrary.org/obo/MONDO_0005399
T11 819-822 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T12 886-894 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T13 1342-1361 Disease denotes pulmonary embolisms http://purl.obolibrary.org/obo/MONDO_0005279
T14 1452-1455 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T15 1487-1490 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T16 1612-1620 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T17 1720-1728 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T18 1884-1892 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T19 3354-3362 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T20 3623-3635 Disease denotes coagulopathy http://purl.obolibrary.org/obo/MONDO_0001531
T21 3936-3939 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T22 4197-4205 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T23 4310-4322 Disease denotes coagulopathy http://purl.obolibrary.org/obo/MONDO_0001531
T24 4404-4429 Disease denotes deep venous thrombosis is http://purl.obolibrary.org/obo/MONDO_0010432
T25 4409-4426 Disease denotes venous thrombosis http://purl.obolibrary.org/obo/MONDO_0008559
T26 4416-4426 Disease denotes thrombosis http://purl.obolibrary.org/obo/MONDO_0000831
T27 4462-4470 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T28 4730-4739 Disease denotes infection http://purl.obolibrary.org/obo/MONDO_0005550
T29 5048-5066 Disease denotes pulmonary embolism http://purl.obolibrary.org/obo/MONDO_0005279
T30 5315-5324 Disease denotes infection http://purl.obolibrary.org/obo/MONDO_0005550
T31 5519-5522 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T32 5589-5597 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T33 5729-5732 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T34 5778-5786 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T35 5807-5810 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T36 5873-5883 Disease denotes Thrombosis http://purl.obolibrary.org/obo/MONDO_0000831
T37 5987-5995 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T38 6116-6119 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T39 6184-6192 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T40 6545-6548 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T41 6589-6597 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T42 6681-6684 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399
T43 6897-6905 Disease denotes COVID-19 http://purl.obolibrary.org/obo/MONDO_0100096
T44 6972-6975 Disease denotes VTE http://purl.obolibrary.org/obo/MONDO_0005399

LitCovid-PD-CLO

Id Subject Object Predicate Lexical cue
T1 299-302 http://purl.obolibrary.org/obo/CLO_0051582 denotes has
T2 648-649 http://purl.obolibrary.org/obo/CLO_0001020 denotes a
T3 752-755 http://purl.obolibrary.org/obo/CLO_0051582 denotes has
T4 830-831 http://purl.obolibrary.org/obo/CLO_0001020 denotes a
T5 948-950 http://purl.obolibrary.org/obo/CLO_0001000 denotes 35
T6 2396-2397 http://purl.obolibrary.org/obo/CLO_0001020 denotes a
T7 3186-3187 http://purl.obolibrary.org/obo/CLO_0001020 denotes A
T8 4979-4980 http://purl.obolibrary.org/obo/CLO_0001020 denotes a
T9 5071-5072 http://purl.obolibrary.org/obo/CLO_0001020 denotes a
T10 5216-5219 http://purl.obolibrary.org/obo/CLO_0051582 denotes has
T11 5359-5362 http://purl.obolibrary.org/obo/CLO_0051582 denotes has
T12 5651-5652 http://purl.obolibrary.org/obo/CLO_0001020 denotes A
T13 5838-5840 http://purl.obolibrary.org/obo/CLO_0053733 denotes 11
T14 5900-5903 http://purl.obolibrary.org/obo/CLO_0051582 denotes has
T15 6142-6144 http://purl.obolibrary.org/obo/CLO_0053799 denotes 45
T16 6166-6168 http://purl.obolibrary.org/obo/CLO_0053733 denotes 11
T17 6210-6211 http://purl.obolibrary.org/obo/CLO_0001020 denotes a
T18 6465-6466 http://purl.obolibrary.org/obo/CLO_0001020 denotes a
T19 6613-6614 http://purl.obolibrary.org/obo/CLO_0001020 denotes a
T20 7356-7359 http://purl.obolibrary.org/obo/CL_0002009 denotes MDP
T21 7438-7441 http://purl.obolibrary.org/obo/CL_0002009 denotes MDP
T22 7484-7487 http://purl.obolibrary.org/obo/CL_0002009 denotes MDP
T23 7497-7500 http://purl.obolibrary.org/obo/CL_0002009 denotes MDP

LitCovid-PD-CHEBI

Id Subject Object Predicate Lexical cue chebi_id
T1 429-438 Chemical denotes antiviral http://purl.obolibrary.org/obo/CHEBI_22587
T2 1695-1708 Chemical denotes anticoagulant http://purl.obolibrary.org/obo/CHEBI_50249
T3 2724-2729 Chemical denotes group http://purl.obolibrary.org/obo/CHEBI_24433
T4 3435-3440 Chemical denotes group http://purl.obolibrary.org/obo/CHEBI_24433
T5 3839-3844 Chemical denotes group http://purl.obolibrary.org/obo/CHEBI_24433
T6 4609-4616 Chemical denotes heparin http://purl.obolibrary.org/obo/CHEBI_28304
T7 4657-4664 Chemical denotes Heparin http://purl.obolibrary.org/obo/CHEBI_28304
T8 4701-4708 Chemical denotes heparin http://purl.obolibrary.org/obo/CHEBI_28304
T9 4868-4875 Chemical denotes heparin http://purl.obolibrary.org/obo/CHEBI_28304
T10 6304-6312 Chemical denotes medicine http://purl.obolibrary.org/obo/CHEBI_23888
T11 7356-7359 Chemical denotes MDP http://purl.obolibrary.org/obo/CHEBI_59414
T12 7438-7441 Chemical denotes MDP http://purl.obolibrary.org/obo/CHEBI_59414
T13 7484-7487 Chemical denotes MDP http://purl.obolibrary.org/obo/CHEBI_59414
T14 7497-7500 Chemical denotes MDP http://purl.obolibrary.org/obo/CHEBI_59414

LitCovid-sentences

Id Subject Object Predicate Lexical cue
T1 0-71 Sentence denotes Thromboprophylaxis for medical inpatients with coronavirus disease 2019
T2 73-277 Sentence denotes Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the disease it causes, coronavirus disease 2019 (COVID-19), have put health-care and financial systems worldwide under tremendous pressure.
T3 278-368 Sentence denotes At present, COVID-19 has afflicted millions globally and the death toll is rapidly rising.
T4 369-544 Sentence denotes Awaiting the development of effective and safe vaccines and antiviral therapies, researchers are struggling to better understand the disease and optimize supportive treatment.
T5 545-746 Sentence denotes Individuals hospitalized with COVID-19 are often immobilized with serious respiratory failure and have a remarkable pro-coagulant biochemical profile with elevated D-dimer levels and hyperinflammation.
T6 747-824 Sentence denotes This has raised concern about increased risk of venous thromboembolism (VTE).
T7 825-982 Sentence denotes Only a few studies specifically address this complication in COVID-19 and risk estimates range from 1% in ward patients to 35% in intensive care units [1,2].
T8 983-1180 Sentence denotes However, most of these studies are hampered by small sample sizes in selected study populations treated in intensive care units at tertiary-care facilities with very short and incomplete follow up.
T9 1181-1362 Sentence denotes Moreover, some of the studies also include VTEs with uncertain significance for risk of death, such as asymptomatic VTEs diagnosed by screening and subsegmental pulmonary embolisms.
T10 1363-1472 Sentence denotes In conjunction with high mortality in previous studies, cumulative incidence findings of VTE may be inflated.
T11 1473-1740 Sentence denotes Still, recent VTE estimates have garnered considerable media attention and are currently extrapolated to all hospitalized individuals with COVID-19, while data on potential major bleeding complications and risk–benefit of anticoagulant therapy in COVID-19 are sparse.
T12 1741-1893 Sentence denotes Two recent retrospective observational studies have evaluated the effect of anticoagulation (AC) on mortality in individuals hospitalized with COVID-19.
T13 1894-2004 Sentence denotes Paranjpe et al. studied 2773 individuals hospitalized within the Mount Sinai Health System, New York City [3].
T14 2005-2176 Sentence denotes Overall, 786 individuals received treatment-dose AC during their hospital course and median time from admission to AC initiation was 2 days (interquartile range 0–5 days).
T15 2177-2279 Sentence denotes Study participants were followed from hospital admission (T0) until discharge, death, or end of study.
T16 2280-2392 Sentence denotes The authors compared mortality among AC users versus non-users and found similar mortality (22.5% versus 22.8%).
T17 2393-2533 Sentence denotes In a sub-analysis among individuals receiving mechanical ventilation, AC was associated with greater benefit (mortality 29.1% versus 67.2%).
T18 2534-2730 Sentence denotes However, as T0 was date of admission and AC initiation was delayed, the authors introduced immortal person-time among AC users, thereby conferring an artificial survival advantage to the AC group.
T19 2731-2932 Sentence denotes Immortal time bias (or survivor treatment selection bias) can occur in survival analyses where patients who live longer are more likely to receive treatment than patients who suffer an early death [4].
T20 2933-3185 Sentence denotes As an example, Kaplan–Meier survival curves in the paper by Paranjpe et al. give the false illusion of improved survival among AC users when in fact ~25% of AC users were not at risk of death until after day 5 and all non-users were at risk from day 0.
T21 3186-3367 Sentence denotes A frequently cited study by Tang et al. examined the effect of AC, primarily enoxaparin 40–60 mg daily, on 28-day mortality in 449 hospitalized individuals with severe COVID-19 [5].
T22 3368-3481 Sentence denotes Exclusion criteria included hospitalization for <7 days and the AC group was defined as receiving AC for ≥7 days.
T23 3482-3575 Sentence denotes In the primary analysis, the authors found no effect of AC on mortality (30.3% versus 29.7%).
T24 3576-3749 Sentence denotes However, among individuals with sepsis-induced coagulopathy and in those with more than six-fold elevated D-dimer, mortality was lower among the individuals treated with AC.
T25 3750-3905 Sentence denotes The study by Tang et al. is also at risk of immortal time bias unless everyone in the AC group initiated therapy on the day of admission, which is unclear.
T26 3906-4131 Sentence denotes Of greater relevance, neither VTE events nor bleeding risk was detailed and the generalizability was limited on account of the inclusion criteria, meaning that just 449 of 1786 screened patients were included in the analysis.
T27 4132-4353 Sentence denotes The authors sensibly conclude that AC may not benefit unselected COVID-19 patients, but should be considered in certain high-risk patients, for example those with sepsis-induced coagulopathy and markedly elevated D-dimer.
T28 4354-4656 Sentence denotes Of note, recent evidence from Italy suggests that deep venous thrombosis is an infrequent occurrence during COVID-19 and that filling defects on computed tomography angiography may be related to local pulmonary thrombi, and not to embolism, in which case heparin therapy is of questionable benefit [6].
T29 4657-4802 Sentence denotes Heparin therapy and thromboprophylaxis with heparin for individuals with infection and medical inpatients in general remains controversial [7,8].
T30 4803-5176 Sentence denotes Previous studies on thromboprophylaxis with low-molecular-weight heparin (LMWH) have found limited effect on clinically relevant outcomes in hospitalized medical patients with a number-needed-to-treat of approximately 250 to prevent symptomatic pulmonary embolism and a similar number-needed-to-harm in the form of major bleeding, resulting in little or no net benefit [7].
T31 5177-5329 Sentence denotes Moreover, thromboprophylaxis with LMWH has never been shown to prevent death in hospitalized medical patients including those with severe infection [9].
T32 5330-5537 Sentence denotes Prolonged thromboprophylaxis has been considered of potential benefit, but AC extended beyond hospital discharge for medical illness was not found to have an effect on risk for symptomatic VTE or death [10].
T33 5538-5650 Sentence denotes Guidelines on thromboprophylaxis and AC therapy in COVID-19 are rapidly emerging with differing recommendations.
T34 5651-5842 Sentence denotes A recent position paper endorsed by several international societies suggested VTE risk stratification for all individuals with COVID-19 and pharmacological VTE prophylaxis in many cases [11].
T35 5843-6001 Sentence denotes The International Society for Thrombosis and Haemostasis has pushed the case for thromboprophylaxis with LMWH to all patients hospitalized with COVID-19 [12].
T36 6002-6170 Sentence denotes Other authorities have suggested intermediate or therapeutic doses of LMWH for hospitalized patients and extended VTE prophylaxis for up to 45 days post-discharge [11].
T37 6171-6441 Sentence denotes Although the COVID-19 pandemic confers a strong incentive on the medical community to act, we must remain adherent to evidence-based medicine and ethical considerations before changing guidelines from common practice, especially in prophylactic treatment of individuals.
T38 6442-6598 Sentence denotes Consequently, there is a need for high-quality observational studies to better detail the incidence of VTE and bleeding events in individuals with COVID-19.
T39 6599-6809 Sentence denotes There is also a need for information on risk factors and development of validated VTE and bleeding risk prediction models to identify those individuals with COVID who might benefit most from thromboprophylaxis.
T40 6810-7009 Sentence denotes Even more importantly, we need well-conducted clinical trials on thromboprophylaxis in COVID-19 that explore clinically meaningful outcomes including symptomatic VTE, major bleeding events and death.
T41 7010-7195 Sentence denotes These studies are needed to ensure that we do not harm patients, and may inform physicians and policy-makers of the most efficient use of already heavily strained health-care resources.
T42 7197-7221 Sentence denotes Transparency declaration
T43 7222-7282 Sentence denotes The authors declare that there are no conflicts of interest.
T44 7283-7333 Sentence denotes No external funding was received for this article.
T45 7335-7355 Sentence denotes Author contributions
T46 7356-7393 Sentence denotes MDP is lead and corresponding author.
T47 7394-7449 Sentence denotes Conceptualization and investigation were by MDP and JB.
T48 7450-7545 Sentence denotes The original draft was written by MDP and both MDP and JB contributed to reviewing and editing.

LitCovid-PD-HP

Id Subject Object Predicate Lexical cue hp_id
T1 619-638 Phenotype denotes respiratory failure http://purl.obolibrary.org/obo/HP_0002878
T2 700-716 Phenotype denotes elevated D-dimer http://purl.obolibrary.org/obo/HP_0033106
T3 802-817 Phenotype denotes thromboembolism http://purl.obolibrary.org/obo/HP_0001907
T4 1342-1361 Phenotype denotes pulmonary embolisms http://purl.obolibrary.org/obo/HP_0002204
T5 3608-3614 Phenotype denotes sepsis http://purl.obolibrary.org/obo/HP_0100806
T6 3623-3635 Phenotype denotes coagulopathy http://purl.obolibrary.org/obo/HP_0003256
T7 3673-3689 Phenotype denotes elevated D-dimer http://purl.obolibrary.org/obo/HP_0033106
T8 4295-4301 Phenotype denotes sepsis http://purl.obolibrary.org/obo/HP_0100806
T9 4310-4322 Phenotype denotes coagulopathy http://purl.obolibrary.org/obo/HP_0003256
T10 4336-4352 Phenotype denotes elevated D-dimer http://purl.obolibrary.org/obo/HP_0033106
T11 4404-4426 Phenotype denotes deep venous thrombosis http://purl.obolibrary.org/obo/HP_0002625
T12 5048-5066 Phenotype denotes pulmonary embolism http://purl.obolibrary.org/obo/HP_0002204
T13 5308-5324 Phenotype denotes severe infection http://purl.obolibrary.org/obo/HP_0032169