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Published on: June 15, 2019
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COVID-19 and Sepsis
Zeliha Koçak Tufan1,2,3, Bircan Kayaaslan1, Mervyn Mer4
1Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
Turkish Journal of Medical Sciences
|September 30, 2021
Summary
Severe COVID-19 shares similarities with sepsis, involving multi-organ involvement and a cytokine storm. Recognizing COVID-19 as a sepsis syndrome aids in developing treatments to manage immune response and improve patient outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pathology
Background:
- The COVID-19 pandemic has significantly impacted medical literature, particularly discussions on sepsis.
- Many acute manifestations of COVID-19 resemble sepsis caused by other pathogens, necessitating updates to existing definitions to include SARS-CoV-2.
- Severe COVID-19 exhibits high serum cytokine and chemokine levels, akin to sepsis, indicating a systemic inflammatory response.
Purpose of the Study:
- To analyze the similarities and differences between COVID-19 and traditional sepsis.
- To explore the pathogenesis of severe COVID-19, including multi-organ involvement and hypercoagulability.
- To evaluate the relevance of considering severe COVID-19 as a sepsis syndrome for treatment strategies.
Main Methods:
- Review of existing literature and autopsy findings in hospitalized COVID-19 patients.
- Analysis of laboratory parameters (cytokines, chemokines, D-dimer, ferritin, CRP) in severe COVID-19.
- Comparison of clinical and laboratory features of COVID-19 sepsis with bacterial sepsis and hemophagocytic lymphohistiocytosis (HLH).
Main Results:
- COVID-19 involves multiple organs beyond the lungs, with autopsy showing vascular damage, ARDS, and inflammatory infiltration.
- Severe COVID-19 cases display hypercoagulability, involving Virchow's triad, and laboratory alterations suggestive of a cytokine storm.
- Significant overlap exists between SARS-CoV-2 induced cytokine storm and HLH, with viral sepsis showing distinct features from bacterial sepsis regarding systemic inflammation and clinical course.
Conclusions:
- Severe COVID-19 can be conceptualized as a sepsis syndrome, sharing key pathophysiological mechanisms with traditional sepsis.
- Understanding COVID-19 as sepsis aids in developing targeted treatments to modulate the immune response and mitigate organ damage.
- Further research into viral sepsis pathogenesis is crucial for optimizing patient management and improving outcomes in severe COVID-19 cases.
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