COVID-19 and multiorgan failure: A narrative review on potential mechanisms
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REVIEW PAPER
COVID-19 and multiorgan failure: A narrative review on potential mechanisms Tahmineh Mokhtari1,2 · Fatemeh Hassani3 · Neda Ghaffari4 · Babak Ebrahimi4 · Atousa Yarahmadi4 · Ghomareza Hassanzadeh6,5,4 Received: 30 July 2020 / Accepted: 26 September 2020 © Springer Nature B.V. 2020
Abstract The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in December 2019 form Wuhan, China leads to coronavirus disease 2019 (COVID-19) pandemic. While the common cold symptoms are observed in mild cases, COVID-19 is accompanied by multiorgan failure in severe patients. The involvement of different organs in severe patients results in lengthening the hospitalization duration and increasing the mortality rate. In this review, we aimed to investigate the involvement of different organs in COVID-19 patients, particularly in severe cases. Also, we tried to define the potential underlying mechanisms of SARS-CoV2 induced multiorgan failure. The multi-organ dysfunction is characterized by acute lung failure, acute liver failure, acute kidney injury, cardiovascular disease, and as well as a wide spectrum of hematological abnormalities and neurological disorders. The most important mechanisms are related to the direct and indirect pathogenic features of SARS-CoV2. Although the presence of angiotensin-converting enzyme 2, a receptor of SARS-CoV2 in the lung, heart, kidney, testis, liver, lymphocytes, and nervous system was confirmed, there are controversial findings to about the observation of SARS-CoV2 RNA in these organs. Moreover, the organ failure may be induced by the cytokine storm, a result of increased levels of inflammatory mediators, endothelial dysfunction, coagulation abnormalities, and infiltration of inflammatory cells into the organs. Therefore, further investigations are needed to detect the exact mechanisms of pathogenesis. Since the involvement of several organs in COVID-19 patients is important for clinicians, increasing their knowledge may help to improve the outcomes and decrease the rate of mortality and morbidity. Keywords COVID-19 · SARS-CoV2 · Multi-organ failure · Angiotensin-converting enzyme-2 · Cytokine storm · Coagulation
* Ghomareza Hassanzadeh [email protected]
2
Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
Tahmineh Mokhtari [email protected]
3
Fatemeh Hassani [email protected]
Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
4
Neda Ghaffari [email protected]
Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
5
Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
6
Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
Babak Ebrahimi [email protected] Atousa Yarahmadi [email protected] 1
CAS Key Laboratory of Mental H
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