Postmortem examination of COVID‐19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction

Abstract

Aims:Coronavirus disease 2019 caused by SARS-CoV-2 has rapidly evolved into a sweeping pandemic. While its major manifestation is in the respiratory tract, the general extent of organ involvement as well as microscopic changes in the lungs remain insufficiently characterised. Autopsies are essential to elucidate COVID-19-associated organ alterations.Methods: This study reports autopsy findings of 21 COVID-19 patients hospitalised at the University Hospital Basel and at the Cantonal Hospital Baselland, Switzerland. An in-corpore technique was performed to ensure optimal staff safety. Results:The primary cause of death was respiratory failure with exudative diffuse alveolar damage with massive capillary congestion often accompanied by microthrombi despite anticoagulation. Ten cases showed superimposed bronchopneumonia. Further findings included pulmonary embolisms (n=4), alveolar haemorrhage (n=3) and vasculitis (n=1). Pathologies in other organ systems were predominantly attributable to shock; three patients showed signs of generalised thrombotic microangiopathy. Six patients were diagnosed with senile cardiac amyloidosis upon autopsy. Most patients suffered from one or more comorbidities (hypertension, obesity, cardiovascular diseases, diabetes mellitus). Additionally, there was an overall predominance of males and individuals with blood group A (81% and 65%, respectively). All relevant histological slides are linked as open-source scans in supplementary files. Conclusions:This study provides an overview of post-mortem findings in COVID-19 cases, implying that hypertensive, elderly, obese, male individuals with severe cardiovascular comorbidities as well as those with blood group A may have a lower threshold of tolerance for COVID-19. This provides a pathophysiological explanation for higher mortality rates amongst these patients.

The involvement of Central Nervous System and sequence variability of Severe Adult Respiratory Syndrome – Coronavirus-2 revealed in autopsy tissue samples: a case report.

“…CNS-infection in relation to COVID-19 is further supported, by a report where the presence of the virus in neural and capillary endothelial cells, in the frontal lobe of a patient with COVID-19 infection and neurological symptoms, were documented by electron microscopy 18 . The microscopic examination of the brain revealed no signs of encephalitis, microthrombi, or in ammation, which is in keeping with Menter T et al 3 , who, apart from unspeci c microscopic ndings, registered a low viral load in neurological tissue.…”

“…The autopsy was performed according to ISO 17020 standards and included a whole body post-mortem computer tomography (PMCT) prior to the external and internal examination, the thorough biosampling, and the additional supplementary toxicological and histopathological tests, as well as extensive microbiological analyses, were performed. According to recently published autopsy studies, the primary cause of death in individuals who died of COVID-19 was a respiratory failure with exudative diffuse alveolar damage 3 . Additionally, it has been revealed that the leading causes of death in COVID-19-positive patients are bronchopneumonia, massive pulmonary embolism, and alveolar haemorrhage 3,4 .…”

“…According to recently published autopsy studies, the primary cause of death in individuals who died of COVID-19 was a respiratory failure with exudative diffuse alveolar damage 3 . Additionally, it has been revealed that the leading causes of death in COVID-19-positive patients are bronchopneumonia, massive pulmonary embolism, and alveolar haemorrhage 3,4 .…”

Transcriptional Profiling of Leukocytes in Critically Ill COVID19 Patients: Implications for Interferon Response and Coagulation

“…One of the key clinical features of COVID19 is upregulation of the pro-thrombotic phenotype and microvascular complications, leading to COVID19-associated coagulopathy (7). This is characterized by venous, arterial, and microvascular thrombosis despite the use of anti-coagulant therapies (32)(33)(34)(35)(36)(37)(38). Our study provides compelling evidence of COVID19 associated changes in coagulation-related gene expression levels that may exacerbate thrombosis caused by endothelial cell injury and platelet activation in COVID19+ ICU patients (7).…”

A novel optical biosensor for the early diagnosis of sepsis and severe COVID-19: the PROUD study

“…Although endothelial damage is not a prominent feature of viral infections, our data indicate that COVID-19 complicated by lower respiratory tract infection leads to profound endothelial damage which is traced by the OB PPG point-of-care device. Indeed, post-mortem lung histology of 21 patients with severe COVID-19 revealed signi cant vascular damage dominated by diffuse exudation in the alveoli, vascular microthrombi and vasculitis (10)(11)(12).…”