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Arch Pathol Lab Med
. 2021 Jan 15.
doi: 10.5858/arpa.2020-0786-SA. Online ahead of print.
A Postmortem Portrait of the Coronavirus Disease 2019 (COVID-19) Pandemic: A Large Multiinstitutional Autopsy Survey Study
Jody E Hooper 1 , Robert F Padera 2 , Marisa Dolhnikoff 3 , Luiz Fernando Ferraz da Silva 3 , Amaro Nunes Duarte-Neto 3 , Meghan E Kapp 4 , J Matthew Lacy 5 , Thais Mauad 3 , Paulo Hilario Nascimento Saldiva 3 , Amy V Rapkiewicz 6 , Dwayne A Wolf 7 , Juan C Felix 8 , Paul Benson 9 , Renata Aparecida de Almeida Monteiro 3 , Elisheva Shanes 10 , Kara L Gawelek 11 , Desiree A Marshall 12 , Michelle M McDonald 13 , William Muller 10 , David S Priemer 14 , Isaac H Solomon 2 , Taylor Zak 10 , Meenakshi B Bhattacharjee 13 , Lucy Fu 10 , Andrea R Gilbert 15 , Holly L Harper 16 , Silvio Litovsky 9 , Jon Lomasney 10 , Sharon L Mount 17 , Stephanie Reilly 9 , Miroslav Sekulic 18 , Thora S Steffensen 19 , Kirsten J Threlkeld 17 , Bihong Zhao 13 , Alex K Williamson 20
Affiliations
- PMID: 33449998
- DOI: 10.5858/arpa.2020-0786-SA
Abstract
Context: This study represents the largest compilation to date of clinical and postmortem data from decedents with coronavirus disease 2019 (COVID-19). It will augment previously published small series of autopsy case reports, refine clinicopathologic considerations, and improve the accuracy of future vital statistical reporting.
Objective: To accurately reflect the pre-existing diseases and pathologic conditions of decedents with Sars-CoV-2 infection through autopsy.
Design: Comprehensive data from 135 autopsy evaluations of COVID-19-positive decedents is presented, including histologic assessment. Postmortem examinations were performed by 36 pathologists at 19 medical centers or forensic institutions in the United States and Brazil. Data from each autopsy were collected through the online submission of multiple choice and openended survey responses.
Results: Patients dying of or with COVID-19 had an average of 8.89 pathologic conditions documented at autopsy, spanning a combination of prior chronic disease and acute conditions acquired during hospitalization. Virtually all decedents were cited as having more than one preexisting condition, encompassing an average of 2.88 such diseases each. Clinical conditions during terminal hospitalization were cited 395 times for the 135 autopsied decedents and predominantly encompassed acute failure of multiple organ systems and/or impaired coagulation. Myocarditis was rarely cited.
Conclusions: Cause-of-death statements in both autopsy reports and death certificates may not encompass the severity or spectrum of co-morbid conditions in those dying of or with COVID-19. If supported by additional research, this finding may have implications for public health decisions and reporting moving forward through the pandemic.