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Ein schwerer Verlauf mit t\u00f6dlichem Ausgang ist m\u00f6glich und unvorhersehbar.<\/jats:p><\/jats:sec><jats:sec><jats:title>Fragestellung<\/jats:title><jats:p>Welche Organsysteme sind prim\u00e4r betroffen? Welche Organver\u00e4nderungen pr\u00e4disponieren f\u00fcr einen ung\u00fcnstigen Verlauf? Welche Organsch\u00e4digungen finden sich bei letalem Ausgang?<\/jats:p><\/jats:sec><jats:sec><jats:title>Material und Methode<\/jats:title><jats:p>Daten aus publizierten Obduktionsstudien (davon 28\u00a0eigene publizierte F\u00e4lle) in Hinblick auf Organsch\u00e4digung und m\u00f6gliche Todesursachen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ergebnisse<\/jats:title><jats:p>Die schwersten Ver\u00e4nderungen finden sich in den Lungen in Form eines diffusen Alveolarschadens als akutes Atemnotsyndrom des Erwachsenen (ARDS), zum Teil bereits mit Fibrose. Thrombosen in kleinen bis mittelgro\u00dfen Pulmonalarterien sind mit Lungeninfarkten vergesellschaftet. H\u00e4ufige Komplikationen sind bakterielle Bronchopneumonien, seltener Pilzpneumonien. Pulmonale Thromboembolien finden sich in 20\u201330\u202f% der t\u00f6dlichen Verl\u00e4ufe, auch bei Fehlen einer tiefen Beinvenenthrombose. Eine intestinale Beteiligung von COVID-19 kann mit isch\u00e4mischer Sch\u00e4digung des Darmes einhergehen, in erster Linie bedingt durch Schock oder lokale Thrombose. Die Nieren zeigen eine akute Tubulussch\u00e4digung als Ausdruck eines akuten Nierenversagens, Lymphknoten und Milz einen Schwund der Lymphozyten, die Nebennierenrinde eine Hyperplasie. In der Leber finden sich h\u00e4ufig eine Steatose, Leberzellnekrosen, ein portales Entz\u00fcndungsinfiltrat und eine Proliferation der Kupffer-Zellen. H\u00e4ufige Grunderkrankungen sind in den Autopsiekollektiven arterieller Hypertonus mit hypertensiver und isch\u00e4mischer Kardiomyopathie und Diabetes mellitus. In gro\u00dfen bev\u00f6lkerungsbasierten Studien ergibt sich aber f\u00fcr Hypertoniker im Gegensatz zu Diabetikern kein erh\u00f6htes Mortalit\u00e4tsrisiko.<\/jats:p><\/jats:sec><jats:sec><jats:title>Schlussfolgerungen<\/jats:title><jats:p>Pulmonale Kreislaufst\u00f6rungen mit arteriellen Thrombosen, Infarkten und Pneumonien sind wesentliche und oft letale Komplikationen des ARDS bei COVID-19. Die Erkenntnisse aus Obduktionsstudien haben Therapie und Prophylaxe beeinflusst.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00292-021-00913-0","type":"journal-article","created":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T19:05:55Z","timestamp":1613070355000},"page":"155-163","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Systemische Auswirkungen und klinische Aspekte der SARS-CoV-2-Infektion","Systemic consequences and clinical aspects of SARS-CoV-2 infection"],"prefix":"10.1007","volume":"42","author":[{"given":"Sigurd F.","family":"Lax","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristijan","family":"Skok","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter M.","family":"Zechner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Setaffy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harald H.","family":"Kessler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Kaufmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Vander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalija","family":"Coki\u0107","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ur\u0161a","family":"Maierhofer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ute","family":"Bargfrieder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Trauner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"913_CR1","doi-asserted-by":"publisher","first-page":"1705","DOI":"10.1016\/S0140-6736(20)31030-8","volume":"395","author":"FJ de Abajo","year":"2020","unstructured":"de Abajo\u00a0FJ, Rodriguez-Martin\u00a0S, Lerma\u00a0V et al (2020) Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a\u00a0case-population study. 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