This study aimed to assess the key laboratory features displayed by coronavirus disease 2019 (COVID-19) inpatients that are associated with mild, moderate, severe, and fatal courses of the disease, and through a longitudinal follow-up, to understand the dynamics of the COVID-19 pathophysiology. All severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients admitted to the University Hospital in Motol between March and June 2020 were included in this study. A severe course of COVID-19 was associated with an elevation of proinflammatory markers; an efflux of immature granulocytes into peripheral blood; the activation of CD8 T cells, which infiltrated the lungs; transient liver disease. In particular, the elevation of serum gamma-glutamyl transferase (GGT) and histological signs of cholestasis were highly specific for patients with a severe form of the disease. In contrast, patients with a fatal course of COVID-19 failed to upregulate markers of inflammation, showed discoordination of the immune response, and progressed toward acute kidney failure. COVID-19 is a disease with a multi-organ affinity that is characterized by the activation of innate and cellular adaptive immunity. Biliary lesions with an elevation of GGT and the organ infiltration of interleukin 6 (IL-6)-producing cells are the defining characteristics for patients with the fulminant disease.

Department of Anesthesiology and Intensive Care Medicine 2nd Faculty of Medicine Charles University and University Hospital in Motol 150 06 Prague Czech Republic

Department of Immunology 2nd Faculty of Medicine Charles University and University Hospital in Motol 150 06 Prague Czech Republic

Department of Infectious Diseases University Hospital in Motol 150 06 Prague Czech Republic

Department of Pathology and Molecular Medicine 2nd Faculty of Medicine Charles University and University Hospital in Motol 150 06 Prague Czech Republic

Department of Pediatrics 1st Faculty of Medicine Charles University and Thomayer's Hospital 140 59 Prague Czech Republic

Department of Pneumology 2nd Faculty of Medicine Charles University and University Hospital in Motol 150 06 Prague Czech Republic

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