Autopsy Findings and Venous Thromboembolism in Patients With COVID-19
By D. Wichmann, J. Sperhake, M. Lütgehetmann, S. Steurer, C. Edler, A. Heinemann, F. Heinrich, H. Mushumba, I. Kniep, A. Schröder and 17 more. Annals of Internal Medicine, 2020
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Background: The new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS–CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features. Objective: To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests. Design: Prospective cohort study. Setting: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction–confirmed diagnosis of COVID-19. Patients: The first 12 consecutive COVID-19–positive deaths. Measurements: Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. Results: Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital (n = 10) or outpatient sector (n = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem computed tomography revealed reticular infiltration of the lungs with severe bilateral, dense consolidation, whereas histomorphologically diffuse alveolar damage was seen in 8 patients. In all patients, SARS–CoV-2 RNA was detected in the lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart. Limitation: Limited sample size. Conclusion: The high incidence of thromboembolic events suggests an important role of COVID-19–induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19–related death, as well as possible therapeutic interventions to reduce it. Primary Funding Source: University Medical Center Hamburg-Eppendorf.
Subfields: Dermatology, Infectious Diseases
View Paper: https://www.semanticscholar.org/paper/744a761e527b6258a9d3b145252c6107e66911a9
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Citations in the corpus
- Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19 (2020, background): “formation, organization, and fibrosis, was also observed in COVID-19, but with more cellular fibromyxoid exudates in the alveoli and small airways [48, 49].”
- COVID-19 is, in the end, an endothelial disease (2020, background): “commonly complicate COVID-19, pathological processes that clearly depend on deranged endothelial functions.(49) NETs induced by inflammatory cytokines activate procoagulant functions of endothelial”
- Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis (2020, positive): “Autopsy studies have provided some essential insights into this prothrombotic state in COVID-19 [34,44,55].”
- Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome: Results From a Prospective, Single-Center, Clinicopathologic Case Series (2020, background): “Notably, pulmonary microthrombosis was observed in all cases in Wichmann and colleagues' study (30).”