tetano
Editor, Senior Moderator
Respiration
. 2021 Sep 15;1-11.
doi: 10.1159/000518914. Online ahead of print.
Autopsy-Based Pulmonary and Vascular Pathology: Pulmonary Endotheliitis and Multi-Organ Involvement in COVID-19 Associated Deaths
Martina Haberecker[SUP] 1 [/SUP], Esther Irene Schwarz[SUP] 2 [/SUP], Peter Steiger[SUP] 3 [/SUP], Karl Frontzek[SUP] 4 [/SUP], Felix Scholkmann[SUP] 5 [/SUP], Xiankun Zeng[SUP] 6 [/SUP], Sylvia Höller[SUP] 1 [/SUP], Holger Moch[SUP] 1 [/SUP], Zsuzsanna Varga[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Findings from autopsies have provided evidence on systemic microvascular damage as one of the underlying mechanisms of Coronavirus disease 2019 (CO-VID-19). The aim of this study was to correlate autopsy-based cause of death in SARS-CoV-2, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients with chest imaging and severity grade of pulmonary and systemic morphological vascular pathology.
Methods: Fifteen SARS-CoV-2 positive autopsies with clinically distinct presentations (age 22-89 years) were retrospectively analyzed with focus on vascular, thromboembolic, and ischemic changes in pulmonary and in extrapulmonary sites. Eight patients died due to COVID-19 associated respiratory failure with diffuse alveolar damage in various stages and/or multi-organ failure, whereas other reasons such as cardiac decompensation, complication of malignant tumors, or septic shock were the cause of death in 7 further patients. The severity of gross and histopathological changes was semi-quantitatively scored as 0 (absent), 1 (mild), and 3 (severe). Severity scores between the 2 groups were correlated with selected clinical parameters, initial chest imaging, autopsy-based cause of death, and compared using Pearson χ2 and Mann-Whitney U tests.
Results: Severe pulmonary endotheliitis (p = 0.031, p = 0.029) and multi-organ involvement (p = 0.026, p = 0.006) correlated significantly with COVID-19 associated death. Pulmonary microthrombi showed limited statistical correlation, while tissue necrosis, gross pulmonary embolism, and bacterial superinfection did not differentiate the 2 study groups. Chest imaging at hospital admission did not differ either.
Conclusions: Extensive pulmonary endotheliitis and multi-organ involvement are characteristic autopsy features in fatal CO-VID-19 associated deaths. Thromboembolic and ischemic events and bacterial superinfections occur frequently in SARS-CoV-2 infection independently of outcome.
Keywords: Adult respiratory distress syndrome; Coronavirus disease-19; Endothelial dysfunction; Multi-organ failure; Respiratory failure.
. 2021 Sep 15;1-11.
doi: 10.1159/000518914. Online ahead of print.
Autopsy-Based Pulmonary and Vascular Pathology: Pulmonary Endotheliitis and Multi-Organ Involvement in COVID-19 Associated Deaths
Martina Haberecker[SUP] 1 [/SUP], Esther Irene Schwarz[SUP] 2 [/SUP], Peter Steiger[SUP] 3 [/SUP], Karl Frontzek[SUP] 4 [/SUP], Felix Scholkmann[SUP] 5 [/SUP], Xiankun Zeng[SUP] 6 [/SUP], Sylvia Höller[SUP] 1 [/SUP], Holger Moch[SUP] 1 [/SUP], Zsuzsanna Varga[SUP] 1 [/SUP]
Affiliations
- PMID: 34525475
- DOI: 10.1159/000518914
Abstract
Background: Findings from autopsies have provided evidence on systemic microvascular damage as one of the underlying mechanisms of Coronavirus disease 2019 (CO-VID-19). The aim of this study was to correlate autopsy-based cause of death in SARS-CoV-2, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients with chest imaging and severity grade of pulmonary and systemic morphological vascular pathology.
Methods: Fifteen SARS-CoV-2 positive autopsies with clinically distinct presentations (age 22-89 years) were retrospectively analyzed with focus on vascular, thromboembolic, and ischemic changes in pulmonary and in extrapulmonary sites. Eight patients died due to COVID-19 associated respiratory failure with diffuse alveolar damage in various stages and/or multi-organ failure, whereas other reasons such as cardiac decompensation, complication of malignant tumors, or septic shock were the cause of death in 7 further patients. The severity of gross and histopathological changes was semi-quantitatively scored as 0 (absent), 1 (mild), and 3 (severe). Severity scores between the 2 groups were correlated with selected clinical parameters, initial chest imaging, autopsy-based cause of death, and compared using Pearson χ2 and Mann-Whitney U tests.
Results: Severe pulmonary endotheliitis (p = 0.031, p = 0.029) and multi-organ involvement (p = 0.026, p = 0.006) correlated significantly with COVID-19 associated death. Pulmonary microthrombi showed limited statistical correlation, while tissue necrosis, gross pulmonary embolism, and bacterial superinfection did not differentiate the 2 study groups. Chest imaging at hospital admission did not differ either.
Conclusions: Extensive pulmonary endotheliitis and multi-organ involvement are characteristic autopsy features in fatal CO-VID-19 associated deaths. Thromboembolic and ischemic events and bacterial superinfections occur frequently in SARS-CoV-2 infection independently of outcome.
Keywords: Adult respiratory distress syndrome; Coronavirus disease-19; Endothelial dysfunction; Multi-organ failure; Respiratory failure.