Pathophysiology of Covid Fatality in

Internal Medicine

PB PAPDI
 Update10th Oct 2020
worldometers.info

CFR 2,9 %
CFR 3,6 %
Penyakit
Penyerta
 I. Pathogenesis

CYTOKINE
STORM

Rabi F, et al. SARS-CoV-2 and Coronavirus Disease 2019: What We

Know So Far. Pathogens 2020, 9, 231; doi:10.3390/pathogens9030231
Typical clinical
progression
- Shivraj Hariram Nilea, Arti Nilea, Jiayin Qiua, Lin Lib, Xu Jiac,*, a, Guoyin Kai * . Cytokine and Growth Factor Reviews 53 (2020) 66–70
- Shiddiqi and Mehra. TheJournal of Heart and Lung Transplantation, Vol 39, No 5, May 2020
Common Complications with Risk
of Fatality
u ARDS
u Thrombosis and Hypercoagulation
u Cardiac Injury
u Acute Kidney Injury
u Diabetic Keto Acidosis
 1. ARDS

u Injury alveolar epithelial cell lining

u Injury endothelial cell lining

u Plasma-rich fluid intraalveolar flooding

u ARDS

u Death

Thompson BT, et al. N Engl J Med 2017; 377:562-572

 2. Thrombosis and
Hypercoalgulation

u Comorbidity
u SARS COV-2

u Endothelial dysfunction

u Hypercoagulation and Thrombosis

u Impaired blood flow

u Death

Amraei R, Rahimi N. Cells 2020, 9, 1652; doi:10.3390/cells9071652

 Endothelial Injury

Hypercoagulation

Libby P, Luscher T. European Heart Journal (2020) 41, 3038–3044 doi:10.1093/eurheartj/ehaa623

 PE

VTE

DVT
Pooled Incidence (%) in
COVID-19 patients
admitted to Hospital
receiving anticoagulation
Postmortem
Autopsy
 3. Cardiac Injury

u Proposed process :
u Myocarditis

u Thrombosis and
Hypercagulation

u Sudden cardiac injury

u Death

Siripanthong B, et al. Heart Rhythm, Vol 17, No 9, September 2020

 4. Acute Kidney Injury
u Innate and adaptive immune
activation

u Hypercoagulation à Impaired
blood flow

u Cross talk between organs

u AKI Risk of Death

Batlle D, et al. JASN 31: 1380–1383, 2020

 5. Diabetic Complications

u SARS-CoV-2 via TLRs and Hyperglycemia via

RAGE (Receptor AGEs)

u Increase intracellular signaling

u Cytokine storm
u Hypercoagulation

u Handicap in Optimal Glycemic control

u DKA

De Francesco EM, Vella V, Belfiore A. Front. Endocrinol. 2020. 11:526

Diabetic Keto Acidosis

u Insufficient insulin

u High BG

u Ketone productions

u Metabolic Acidosis

u Death

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 Conclusion
u Covid-19 is a newly emerging infectious disease with complex
matter
u No convincing evidence yet in regard to definitive treatment

u Battle against Complications to avoid Fatality is a Must

Thank You