COVID-19 and Multiorgan Dysfunction Syndrome

*Jitendra D. Lakhani, Sajni Kapadia, Rohit Choradiya, Roop Preet Gill and Som J. Lakhani*

## **Abstract**

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS. As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about "COVID-19 MODS" is important for treating physicians.

**Keywords:** COVID-19, SARS-CoV-2, Multi-organ dysfunction, cytokine storm, sepsis

### **1. Introduction**

Corona viruses (CoVs) are a group of spherical/pleomorphic, enveloped, single stranded RNA viruses having club shaped glycoprotein projections, having four genera: alpha, beta, gamma and delta. Alpha and beta corona viruses infect many mammalian species ranging from bats to humans. Gamma and Delta Corona viruses affecting mainly birds known as Avian corona viruses [1]. First corona virus was isolated in chick embryo in 1937 and is known as Avian infectious bronchitis virus. The virus affects various organs as it is replicating in epithelial tissues of respiratory, genitourinary and enteric tracts of birds [1, 2]. Evolution of corona virus as etiological agent of avian bronchitis to present COVID-19 pandemic is known to cause involvement of various organs like lung, intestine, liver and brain of animals and humans [2].

SARS-CoV-1, human beta-corona virus was first identified in 2003 as a causative agent of Severe Acute Respiratory Syndrome (SARS) outbreak of China which spread to four other countries [3, 4]. Number of corona viruses were identified then after which included Middle East Respiratory Syndrome (MERS) named MERS-CoV-2 which had features of acute respiratory distress with acute renal failure which was reported in large number of severe MERS cases [5, 6].


#### **Table 1.**

*Evolution of corona viruses and their relation to organ involvement [1–10].*

In December 2019, cases of pneumonia of unknown etiology were reported from Wuhan, China, which was identified to be caused by virus referred as "novel corona virus (NCV)-2019"/"2019-nCoV"and lung manifestation as "novel corona virus pneumonia (NCP)". WHO declared disease caused by new corona virus as COVID-19 (Corona Virus Disease) which appeared in 2019 [7]. As main manifestations of COVID-19 causing virus is Severe Acute Respiratory Syndrome, SARS-CoV-2 was the accepted name of the virus causing COVID-19. This new corona virus, had genetic and phylogenetic similarity to SARS-CoV-1 and MERS-CoV. All these three new corona viruses; SARS-CoV-1, MERS-CoV and SARS-CoV-2 are Beta corona virus causing human disease have some similarity and also having some dissimilarities, which is important to be noted as to understand pathogenicity and manifestations [8].

Though severe respiratory distress is an important feature of COVID-19 infection, it also causes acute kidney injury (AKI) like MERS virus and leads to multi-organ dysfunction syndrome (MODS). Multiple organ dysfunction in SARS-CoV-2 can be designated as MODS-CoV-2 which can represent multi-organ involvement of COVID-19 infection [9]. Like other viruses, genomic sequence of SARS-CoV-2 (COVID-19 virus) is changing over time and such variants are of concern (VOC); as it may cause rapid transmission, more severe disease and insufficient host response (**Table 1**) [10].
