Lancet. SARS-CoV-2 and viral sepsis: observations and hypotheses

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Lancet. 2020 Apr 17. pii: S0140-6736(20)30920-X. doi: 10.1016/S0140-6736(20)30920-X. [Epub ahead of print]
SARS-CoV-2 and viral sepsis: observations and hypotheses.


Li H¹, Liu L², Zhang D³, Xu J⁴, Dai H¹, Tang N⁵, Su X⁶, Cao B⁷.

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Abstract

Since the outbreak of coronavirus disease 2019 (COVID-19), clinicians have tried every effort to understand the disease, and a brief portrait of its clinical features have been identified. In clinical practice, we noticed that many severe or critically ill COVID-19 patients developed typical clinical manifestations of shock, including cold extremities and weak peripheral pulses, even in the absence of overt hypotension. Understanding the mechanism of viral sepsis in COVID-19 is warranted for exploring better clinical care for these patients. With evidence collected from autopsy studies on COVID-19 and basic science research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV, we have put forward several hypotheses about SARS-CoV-2 pathogenesis after multiple rounds of discussion among basic science researchers, pathologists, and clinicians working on COVID-19. We hypothesise that a process called viral sepsis is crucial to the disease mechanism of COVID-19. Although these ideas might be proven imperfect or even wrong later, we believe they can provide inputs and guide directions for basic research at this moment.
Copyright ? 2020 Elsevier Ltd. All rights reserved.



PMID:32311318DOI:10.1016/S0140-6736(20)30920-X