Clinical Assessment of Extra Pulmonary Manifestation of Coronavirus Disease -19 and its Relation to Severity of The Disease

COVID-19 not only affects the respiratory system but also causes multiple organ affection such as renal, hepatic, GIT and blood as an extrapulmonary manifestation of COVID-19, this manifestation ranging from mild and moderate to severe and critical patients who need ICU. But the severe and critical cases of covid 19 are more with extrapulmonary than cases of covid 19 without extrapulmonary manifestations. To assess the correlation between the rapidity of COVID-19 progression and extrapulmonary organ injuries, these extrapulmonary manifestations will guide us for proper treatment approaches to avoid decompensation. The current observational study included seventy patients with extrapulmonary manifestation of covid19 compared to thirty covid 19 patients without extrapulmonary manifestations. Demographic, clinical and laboratory parameters including CBC, serum ALT, AST ALB, Creatinine, Urea and RT-PCR for covid 19 and CT chest were recorded. Seventy COVID-19 patients with extrapulmonary manifestations were included,34 were females and 36 were males. their age ranged from 42 to 69 years, together with thirty of covid 19 patients without extra pulmonary manifestations as 11 were females and 19 were males. their age ranged from 35 to 64 years,  each Group were subdivided according to severity and rapidity of progression of disease into three groups: non-severe: patients with non-severe  ( Fever, respiratory symptoms, imaging findings of pneumonia ),  severe patients with any of the followings (Respiratory distress, RR ≥30 times/min, SpO2 <93% at rest, PaO2/FiO2 ≤ 300 mmHg, Patients showing a rapid progression (>50%) on CT imaging within 24- 48 hours)  and critical patients with any of the followings ( Respiratory failure, need mechanical assistance, Shock, multiple organ failure, intensive care unit is needed). The data demonstrated a significantly increased percentage of critical severity, increased percentage of ICU admission (65.7%), use of empirical anti-biotic, dexamethasone and Immune-modulatory drugs in covid 19 patients with extrapulmonary manifestations when compared with covid 19 patients without extrapulmonary manifestations. COVID-19 not only affects the respiratory system but also causes multiple organ affection such as renal, hepatic, GIT and blood. The clinician should be more understating about these extrapulmonary manifestations to avoid their complications.