tetano
Editor, Senior Moderator
Int J Legal Med
. 2020 Jun 4.
doi: 10.1007/s00414-020-02317-w. Online ahead of print.
Dying With SARS-CoV-2 Infection-An Autopsy Study of the First Consecutive 80 Cases in Hamburg, Germany
Carolin Edler[SUP] 1 [/SUP], Ann Sophie Schr?der[SUP] 1 [/SUP], Martin Aepfelbacher[SUP] 2 [/SUP], Antonia Fitzek[SUP] 1 [/SUP], Axel Heinemann[SUP] 1 [/SUP], Fabian Heinrich[SUP] 1 [/SUP], Anke Klein[SUP] 1 [/SUP], Felicia Langenwalder[SUP] 1 [/SUP], Marc L?tgehetmann[SUP] 3 [/SUP], Kira Mei?ner[SUP] 1 [/SUP], Klaus P?schel[SUP] 1 [/SUP], Julia Sch?dler[SUP] 1 [/SUP], Stefan Steurer[SUP] 2 [/SUP], Herbert Mushumba[SUP] 1 [/SUP], Jan-Peter Sperhake[SUP] 4 [/SUP]
Affiliations
Abstract
Autopsies of deceased with a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide important insights into the novel disease and its course. Furthermore, autopsies are essential for the correct statistical recording of the coronavirus disease 2019 (COVID-19) deaths. In the northern German Federal State of Hamburg, all deaths of Hamburg citizens with ante- or postmortem PCR-confirmed SARS-CoV-2 infection have been autopsied since the outbreak of the pandemic in Germany. Our evaluation provides a systematic overview of the first 80 consecutive full autopsies. A proposal for the categorisation of deaths with SARS-CoV-2 infection is presented (category 1: definite COVID-19 death; category 2: probable COVID-19 death; category 3: possible COVID-19 death with an equal alternative cause of death; category 4: SARS-CoV-2 detection with cause of death not associated to COVID-19). In six cases, SARS-CoV-2 infection was diagnosed postmortem by a positive PCR test in a nasopharyngeal or lung tissue swab. In the other 74 cases, SARS-CoV-2 infection had already been known antemortem. The deceased were aged between 52 and 96 years (average 79.2 years, median 82.4 years). In the study cohort, 34 deceased were female (38%) and 46 male (62%). Overall, 38% of the deceased were overweight or obese. All deceased, except for two women, in whom no significant pre-existing conditions were found autoptically, had relevant comorbidities (in descending order of frequency): (1) diseases of the cardiovascular system, (2) lung diseases, (3) central nervous system diseases, (4) kidney diseases, and (5) diabetes mellitus. A total of 76 cases (95%) were classified as COVID-19 deaths, corresponding to categories 1-3. Four deaths (5%) were defined as non-COVID-19 deaths with virus-independent causes of death. In eight cases, pneumonia was combined with a fulminant pulmonary artery embolism. Peripheral pulmonary artery embolisms were found in nine other cases. Overall, deep vein thrombosis has been found in 40% of the cases. This study provides the largest overview of autopsies of SARS-CoV-2-infected patients presented so far.
Keywords: Autopsy; COVID-19; Coronavirus; Pulmonary embolism; SARS-CoV-2; Venous thromboembolic disease.
. 2020 Jun 4.
doi: 10.1007/s00414-020-02317-w. Online ahead of print.
Dying With SARS-CoV-2 Infection-An Autopsy Study of the First Consecutive 80 Cases in Hamburg, Germany
Carolin Edler[SUP] 1 [/SUP], Ann Sophie Schr?der[SUP] 1 [/SUP], Martin Aepfelbacher[SUP] 2 [/SUP], Antonia Fitzek[SUP] 1 [/SUP], Axel Heinemann[SUP] 1 [/SUP], Fabian Heinrich[SUP] 1 [/SUP], Anke Klein[SUP] 1 [/SUP], Felicia Langenwalder[SUP] 1 [/SUP], Marc L?tgehetmann[SUP] 3 [/SUP], Kira Mei?ner[SUP] 1 [/SUP], Klaus P?schel[SUP] 1 [/SUP], Julia Sch?dler[SUP] 1 [/SUP], Stefan Steurer[SUP] 2 [/SUP], Herbert Mushumba[SUP] 1 [/SUP], Jan-Peter Sperhake[SUP] 4 [/SUP]
Affiliations
- PMID: 32500199
- DOI: 10.1007/s00414-020-02317-w
Abstract
Autopsies of deceased with a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide important insights into the novel disease and its course. Furthermore, autopsies are essential for the correct statistical recording of the coronavirus disease 2019 (COVID-19) deaths. In the northern German Federal State of Hamburg, all deaths of Hamburg citizens with ante- or postmortem PCR-confirmed SARS-CoV-2 infection have been autopsied since the outbreak of the pandemic in Germany. Our evaluation provides a systematic overview of the first 80 consecutive full autopsies. A proposal for the categorisation of deaths with SARS-CoV-2 infection is presented (category 1: definite COVID-19 death; category 2: probable COVID-19 death; category 3: possible COVID-19 death with an equal alternative cause of death; category 4: SARS-CoV-2 detection with cause of death not associated to COVID-19). In six cases, SARS-CoV-2 infection was diagnosed postmortem by a positive PCR test in a nasopharyngeal or lung tissue swab. In the other 74 cases, SARS-CoV-2 infection had already been known antemortem. The deceased were aged between 52 and 96 years (average 79.2 years, median 82.4 years). In the study cohort, 34 deceased were female (38%) and 46 male (62%). Overall, 38% of the deceased were overweight or obese. All deceased, except for two women, in whom no significant pre-existing conditions were found autoptically, had relevant comorbidities (in descending order of frequency): (1) diseases of the cardiovascular system, (2) lung diseases, (3) central nervous system diseases, (4) kidney diseases, and (5) diabetes mellitus. A total of 76 cases (95%) were classified as COVID-19 deaths, corresponding to categories 1-3. Four deaths (5%) were defined as non-COVID-19 deaths with virus-independent causes of death. In eight cases, pneumonia was combined with a fulminant pulmonary artery embolism. Peripheral pulmonary artery embolisms were found in nine other cases. Overall, deep vein thrombosis has been found in 40% of the cases. This study provides the largest overview of autopsies of SARS-CoV-2-infected patients presented so far.
Keywords: Autopsy; COVID-19; Coronavirus; Pulmonary embolism; SARS-CoV-2; Venous thromboembolic disease.