SARS-CoV-2-Infection (COVID-19): Clinical Course, Viral Acute Respiratory Distress Syndrome (ARDS) and Cause(s) of Death

Abstract

SARS-CoV-2-infected symptomatic patients often suffer from high fever and loss of appetite which are responsible for the deficit of fluids and of protein intake. Many patients admitted to the emergency room are, therefore, hypovolemic and hypoproteinemic and often suffer from respiratory distress accompanied by ground glass opacities in the CT scan of the lungs. Ischemic damage in the lung capillaries is responsible for the microscopic hallmark, diffuse alveolar damage (DAD) characterized by hyaline membrane formation, fluid invasion of the alveoli, and progressive arrest of blood flow in the pulmonary vessels. The consequences are progressive congestion, increase in lung weight, and progressive hypoxia (progressive severity of ARDS). Sequestration of blood in the lungs worsens hypovolemia and ischemia in different organs. This is most probably responsible for the recruitment of inflammatory cells into the ischemic peripheral tissues, the release of acute-phase mediators, and for the persistence of elevated serum levels of positive acute-phase markers and of hypoalbuminemia. Autopsy studies have been performed mostly in patients who died in the ICU after SARS-CoV-2 infection because of progressive acute respiratory distress syndrome (ARDS). In the death certification charts, after respiratory insufficiency, hypovolemic heart failure should be mentioned as the main cause of death.

SARS‐CoV‐2 infection of polarized human airway epithelium induces necroptosis that causes airway epithelial barrier dysfunction

“…SARS‐CoV‐2 infection causes coronavirus disease 2019 (COVID‐19), which has become a worldwide pandemic. The symptoms of COVID‐19 vary from mild fever, cough, and myalgia to severe acute respiratory distress syndrome (ARDS) 3–5 . Even though it is rapidly transmitted among people, the mortality rate reached 2% early in the pandemic and the most severe cases were found in immunocompromised patients and patients with underlying conditions 6 …”

Portal vein gas is a sign of intestinal necrosis after pesticide poisoning: a case report

“…Severe manifestations often present as dyspnea and alterations in consciousness. 5 Currently, there is no specific treatment for organophosphate intoxication, and symptomatic supportive treatment is predominantly used. Organophosphate pesticides have a direct effect on the gastrointestinal tract.…”

Clinical characteristics and prognosis of patients with COVID-19 on mechanical ventilation undergoing continuous renal replacement therapy

“…The primary causes of death in COVID-19, as widely recognized, are respiratory failure [ 41 , 42 ] and multiple organ failure [ 43 ]. In our study, refractory respiratory failure was the predominant cause of death in the non-CRRT group, which aligns with the typical progression of severe respiratory diseases.…”

“…In the CRRT group, however, the leading cause of death was shock with multi-organ failure, indicating the complexity and severity of cases requiring CRRT [ 44 ]. Notably, cardiac deaths were also higher in the CRRT group, suggesting the need for vigilant cardiac monitoring in these critically ill patients [ 41 ]. It is crucial to recognize that while refractory respiratory failure was also observed in the CRRT group, the elevated mortality rate in these patients might not be solely due to CRRT.…”