COVID-19: Complications

With Sean P. Elliott, MD

Prarthana Mehta, prarthanamehta15@gmail.com

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 COVID-19: Epidemiology

December 2019 March 2020

Wuhan, China: WHO:

SARS-CoV-2 responsible COVID-19 qualified as
for COVID-19 pandemic worldwide

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 COVID-19: Epidemiology

5% Critical
Transfer to ICU

80% Mild 15% Severe

Requires medical
attention

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 COVID-19: Epidemiology

Mortality estimates:
16%
> 14%
14%
12%
10%
10%
8% 7%
6%
4.2%
4%
2%
0%
Overall > 80 years Cardiovascular Diabetes
old disease mellitus
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 Severe COVID-19: Risk Factors

Wuhan, China experience: comorbidities severe/fatal disease (3 studies):

35%
24 30%
30%
25% 12 22% 2 22%
20%
15%
10%
6%
5%
0%
Hypertension Diabetes mellitus Coronary heart disease Cerebrovascular disease

Please note, the numbers may change as the situation is evolving rapidly.
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 Severe COVID-19: Pathogenesis
The hypothetical link/binding site should NOT be construed
as a reason to stop treatment with ACE-inhibitors.

Found on the surface of ACE2 expression

epithelial cells in: increased by:

• Lung • ACE inhibitors

• Intestine • Angiotensin II type1

receptor blockers
• Kidney

Target cell binding: • Blood vessels More binding sites

for SARS-CoV-2
ACE-2
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 Critical COVID-19: Risk Factors

5% of all patients demonstrate progression of:

ARDS Hypotensive shock Multiple organ dysfunction

Risk:
• Older age • Refractory cases (more at risk:
(median age: 60 years old) male, older, anorexic, presenting
without typical fever)
• Comorbid conditions
(diabetes, cardiovascular • SpO2 < 90%
disease, hypertension)

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 Critical COVID-19: Risk Factors

Median time: 9 10 days

Initial presentation of ICU transfer/

upper respiratory onset of critical care
symptoms

Critical care needs:

respiratory support

Cause of death?

Progressive hypoxia Multiple organ failure Hypotensive shock

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 Critical COVID-19: Complications

Characterized by: hypoxemic

Acute respiratory
respiratory failure, bilateral Associated with VQ mismatch
distress
infiltrates due to diffuse and pulmonary shunting
syndrome (ARDS) alveolar damage

Unable to successfully
ventilate

Peripheral shock: Multiple organ dysfunction

Septic shock
causing vasodilation (mostly kidneys)

Increased mortality (22 62%) Refractory COVID-19 disease

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 COVID-19 vs. Other Respiratory Diseases

Other respiratory
diseases:

• Influenza
COVID-19 Extensive
• Rhinovirus cases
overlap
• Whooping cough
• Atypical
pneumonia

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 COVID-19 vs. Other Respiratory Diseases

Extensive overlap Distinction

• Initial presentation • Exposure?
• Clinical: flu-like illness • Initial presentation: nonspecific
• Laboratory: more commonly • Chest CT (COVID-19: bilateral, ground-glass
lymphopenia with COVID-19 opacities and diffuse pneumonia vs. unilateral,
typically more patchy shadows)
• Pneumonia
• Kidney abnormalities (COVID-19: elevated BUN
• Potential progression to severe and creatinine)
disease
• Cardiac abnormalities (COVID-19: elevated
• Critical complications tronponins, abnormal ECG)
• Liver function abnormalities (COVID-19: increase of
AST, ALT, GGT, LDH, a-HBDH)
AST = aspartate aminotransferase; ALT = alanine aminotransferase; GGT = gamma-glutamyl transpeptidase; LDH = lactate dehydrogenase;
Prarthana Mehta, prarthanamehta15@gmail.com
a-HBDH = alpha-hydroxybutyric dehydrogenase
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 At Risk for Severe/Critical COVID-19

Older age Comorbidities

Median age Hypertension, coronary artery

= 60 years disease, cerebrovascular disease,
diabetes mellitus type 1 and 2,
chronic lung disease,
moderate to severe asthma

SpO2 < 90% Diffuse, ground-glass opacities (chest CT)

Becoming case definition of COVID-19

patients at risk for critical progression

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 This document is a property of: Prarthana Mehta

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