Pathological Features in 100 Deceased Patients With COVID-19 in Correlation With Clinical and Laboratory Data

Abstract

Background: Autopsies on COVID-19 deceased patients have many limitations due to necessary epidemiologic and preventative measures. The ongoing pandemic has caused a significant strain on healthcare systems and is being extensively studied around the world. Clinical data does not always corelate with post-mortem findings. The goal of our study was to find pathognomonic factors associated with COVID-19 mortality in 100 post-mortem full body autopsies.Materials and Methods: Following necessary safety protocol, we performed 100 autopsies on patients who were diagnosed with COVID-19 related death. The macroscopic and microscopic pathologies were evaluated along with clinical and laboratory findings.Results: Extensive coagulopathic changes are seen throughout the bodies of diseased patients. Diffuse alveolar damage is pathognomonic of COVID-19 viral pneumonia, and is the leading cause of lethal outcome in younger patients. Extrapulmonary pathology is predominantly seen in the liver and spleen. Intravascular thrombosis is often widespread and signs of septic shock are often present.Conclusion: The described pathological manifestations of COVID-19 in deceased patients are an insight into the main mechanisms of SARS-CoV-2 associated lethal outcome. The disease bears no obvious bias in severity, but seems to be more severe in some patients, hinting at genetic or epigenetic factors at play.

Is it COVID-19? The value of medicolegal autopsies during the first year of the COVID-19 pandemic

“…However, by recognizing common gross findings of fatal COVID-19 in the absence of a supportive clinical history (red firm lungs characteristic of diffuse alveolar damage, foci of pulmonary consolidation suspicious for pneumonia, and pulmonary thromboemboli), we may identify which decedents will most benefit from confirmatory testing. Our findings support previous autopsy studies that show similar postmortem findings [9] , [10] , [11] , [12] , [13] , [14] .…”

“…To date, numerous autopsy studies have examined the pathologic findings of patients who have died from confirmed acute COVID-19 infection. Pulmonary findings associated with fatal infection include diffuse alveolar damage with hyaline membrane formation, acute pneumonia, reactive type II pneumocytes, perivascular lymphocytic infiltration, increased megakaryocytes, and thromboemboli [9] , [10] , [11] , [12] , [13] , [14] . There is a dearth of studies that examine diagnostic challenges in postmortem identification of COVID-19 infection, especially in the setting of limited resource availability.…”

Clinical, Virological, and Pathological Profile of Patients Who Died of COVID-19: An Autopsy-Based Study From India

“…In the liver, though there is a higher expression of ACE2 enzyme in the ductular epithelial cells, no elevation in the bilirubin levels or any histologic change favoring ductular damage was evident in the present study; this aligns with a previous study by Fan et al [ 21 ]. In the present study, 55% of cases were positive for SARS-CoV-2 in liver tissue on RT-PCR, which is comparable to the observations in previous studies; however, no evidence of hepatocyte injury was seen [ 21 , 22 ]. In contrast to previous studies, vascular thrombosis was not seen in the majority of the cases included in the present study even though the D-dimer levels were elevated in some of these cases [ 23 , 24 ].…”

Who Were Hospitalized Deceased Patients from COVID-19 During the First Year of Pandemic? Retrospective Analysis of 1104 Deceased Patients in South of France

“…Only 2% of patients under 65 years of age had fewer than two comorbidities, suggesting potentially undiagnosed comorbidities. Several articles already focused on this subject and showed that the infection appears to be more severe in certain patients, suggesting that genetic or epigenetic factors are at play [ 34 ]. Surprisingly, although univariate analysis revealed that patients younger than 65 years had more autoimmune and liver disease, multivariate analysis did not identify these factors as being related to premature mortality.…”