From asymptomatic to critical illness: Decoding various clinical stages of Covid-19

Abstract

The clinical course of COVID-19 is variable, with clinical manifestation ranging from 81% mild course to 14% severe course along with 5% critical course in patients. The asymptomatic course is reported to potentially range between 20-70% (avg. 33%). A more severe course is seen in the elderly, those with various chronic diseases, and the immunosuppressed, where the case fatality rate is higher in these risk groups. The disease progresses with various symptoms, such as fever, cough, shortness of breath, malaise, myalgia, taste and smell disorders, diarrhea, sore throat, headache and conjunctivitis. The disease begins with shortness of breath, indicative of lung damage, after an average of 7 to 10 days, and progresses in ARDS, sepsis, and septic shock. Some patients quickly enter shortness of breath, while others gradually develop shortness of breath and chest tightness and burning. The risk factors for a poor prognosis are age, comorbidities, and changes in laboratory tests. Secondary bacterial and fungal infections frequently develop in connection with steroids and immunosuppressants, especially in patients followed in the intensive care unit. Frequent complications in hospitalized patients include pneumonia (75%), ARDS (15%), acute renal failure (9%), and acute liver injury (19%). An increased incidence of heart damage is observed, including acute heart failure, arrhythmias, and myocarditis. 10-25% of the patients hospitalized due to COVID-19 present with prothrombotic coagulopathy, resulting in venous and arterial thromboembolic events. The most common extra-pulmonary symptom is neuropsychiatric involvement, frequently accompanied by insomnia, an impediment to remembering, and an altered state of consciousness. During the course of COVID-19, patients undergo some pathological changes (severe lymphopenia, high levels of CRP, D-dimer, ferritin, etc.) depending on the condition and exposure level of the affected systems as shown by various laboratory tests, and the relevant tests are the guiding elements of risk assessment, clinical monitoring, disease severity, and prognosis setting and therapy decision-making processes.

Use of a combination of the virus-neutralizing monoclonal antibodies casirivimab and imdevimab for mild to moderate COVID-19 in patients at high risk of progression: Results of the non-interventional observational study

“…У большинства (81-92%) пациентов COVID-19 протекает в легкой форме без показаний для госпитализации [9,10]. Несмотря на это, 1/2 больных даже с легким течением новой коронавирусной инфекции нуждаются в терапии кислородом по крайней мере 1 раз на протяжении всего периода заболевания [9].…”

Prevention, diagnostic evaluation, management and prognostic implications of liver disease in critically ill patients with COVID-19

“…Acute liver injury (ALI) has been reported in approximately 19% of patients with COVID-19; however, the percentage increases dramatically, up to 89.2%, in ICU patients[ 60 , 61 ]. The spectrum of ALI in critically ill patients with COVID-19 is wide, varying from simple elevations of LFTs to ALF, the need for advanced support and even the need for transplantation {62-64] .…”

CD4+ T-Cell Depression is Linked to the Severity of COVID-19 and Predicts Mortality

“…The first group consisted of 'asymptomatic' patients without any signs or symptoms; the second group consisted of 'mild/moderate' patients with signs of upper respiratory tract infection or infiltration in the lung but with a peripheral arterial saturation (pulse oximetry) >94% in room air. The third group included 'severe/critical' patients who met at least two of the following criteria: peripheral arterial saturation <94% needing oxygen support, tachypnea (>30/min respiratory rate), and more than 50% progression in lung radiology within 24-48 hours (13,14). Furthermore, we performed another analysis to estimate the mortality of the patients, excluding asymptomatic patients.…”