tetano
Editor, Senior Moderator
Ann Intern Med. 2020 May 6. doi: 10.7326/M20-2003. [Epub ahead of print]
Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study.
Wichmann D[SUP]1[/SUP], Sperhake JP[SUP]1[/SUP], L?tgehetmann M[SUP]1[/SUP], Steurer S[SUP]1[/SUP], Edler C[SUP]1[/SUP], Heinemann A[SUP]1[/SUP], Heinrich F[SUP]1[/SUP], Mushumba H[SUP]1[/SUP], Kniep I[SUP]1[/SUP], Schr?der AS[SUP]1[/SUP], Burdelski C[SUP]1[/SUP], de Heer G[SUP]1[/SUP], Nierhaus A[SUP]1[/SUP], Frings D[SUP]1[/SUP], Pfefferle S[SUP]1[/SUP], Becker H[SUP]2[/SUP], Bredereke-Wiedling H[SUP]3[/SUP], de Weerth A[SUP]4[/SUP], Paschen HR[SUP]5[/SUP], Sheikhzadeh-Eggers S[SUP]6[/SUP], Stang A[SUP]2[/SUP], Schmiedel S[SUP]1[/SUP], Bokemeyer C[SUP]1[/SUP], Addo MM[SUP]1[/SUP], Aepfelbacher M[SUP]1[/SUP], P?schel K[SUP]1[/SUP], Kluge S[SUP]1[/SUP].
Author information
Abstract
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.
PMID:32374815DOI:10.7326/M20-2003
Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study.
Wichmann D[SUP]1[/SUP], Sperhake JP[SUP]1[/SUP], L?tgehetmann M[SUP]1[/SUP], Steurer S[SUP]1[/SUP], Edler C[SUP]1[/SUP], Heinemann A[SUP]1[/SUP], Heinrich F[SUP]1[/SUP], Mushumba H[SUP]1[/SUP], Kniep I[SUP]1[/SUP], Schr?der AS[SUP]1[/SUP], Burdelski C[SUP]1[/SUP], de Heer G[SUP]1[/SUP], Nierhaus A[SUP]1[/SUP], Frings D[SUP]1[/SUP], Pfefferle S[SUP]1[/SUP], Becker H[SUP]2[/SUP], Bredereke-Wiedling H[SUP]3[/SUP], de Weerth A[SUP]4[/SUP], Paschen HR[SUP]5[/SUP], Sheikhzadeh-Eggers S[SUP]6[/SUP], Stang A[SUP]2[/SUP], Schmiedel S[SUP]1[/SUP], Bokemeyer C[SUP]1[/SUP], Addo MM[SUP]1[/SUP], Aepfelbacher M[SUP]1[/SUP], P?schel K[SUP]1[/SUP], Kluge S[SUP]1[/SUP].
Author information
Abstract
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.
PMID:32374815DOI:10.7326/M20-2003