COVID19 Complications

By Dr Deepu Changappa Cheriamane

Complications of COVID 19

In one of the largest studies of hospitalized patients, reviewing 1,099 individuals across China, the admission rate to the intensive care unit (ICU) was 5%.

 In this same study, 6% of all patients required ventilation, whether invasive or non-invasive.

 

ICU patients tend to be older with more comorbidities.

Commonly reported sequelae are:

acute respiratory distress syndrome (ARDS): ~22.5% (range 17-29%)

acute thromboembolic disease

pulmonary embolism

deep vein thrombosis (DVT)

acute cardiac injury: 

elevated troponin levels

myocardial ischemia

cardiac arrest

myocarditis

CNS

delirium

viral encephalitis

diffuse leukoencephalopathy

microhemorrhage (seen in juxtacortical white matter and corpus callosum particularly of the splenium)

stroke: cryptogenic/ischemic

higher mortality and greater severity of stroke in context of COVID-19

secondary infections, e.g. bacterial pneumonia

sepsis

acute kidney injury (AKI)

coagulopathy

disseminated intravascular coagulation (DIC)

multiorgan failure

In a small subgroup of severe ICU cases:

secondary hemophagocytic lymphohistiocytosis (a cytokine storm syndrome)

Risk factors for pulmonary embolism

In a multivariate analysis, an elevated risk of developing PE was associated with:

obesity

elevated D-dimer

elevated CRP

rising D-dimer over time

Pediatric complications

In April 2020, reports started to appear of critically-ill children presenting with a multisystem inflammatory state which bore some resemblance to Kawasaki disease and toxic shock syndrome. Typically abdominal pain and other GI symptoms were present and often evidence of a myocarditis. The presentations necessitated ICU admission and fatalities have been reported. 

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Pathology