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- Title
Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study.
- Authors
Wichmann, Dominic; Sperhake, Jan-Peter; Lütgehetmann, Marc; Steurer, Stefan; Edler, Carolin; Heinemann, Axel; Heinrich, Fabian; Mushumba, Herbert; Kniep, Inga; Schröder, Ann Sophie; Burdelski, Christoph; de Heer, Geraldine; Nierhaus, Axel; Frings, Daniel; Pfefferle, Susanne; Becker, Heinrich; Bredereke-Wiedling, Hanns; de Weerth, Andreas; Paschen, Hans-Richard; Sheikhzadeh-Eggers, Sara
- Abstract
<bold>Background: </bold>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.<bold>Objective: </bold>To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests.<bold>Design: </bold>Prospective cohort study.<bold>Setting: </bold>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.<bold>Patients: </bold>The first 12 consecutive COVID-19-positive deaths.<bold>Measurements: </bold>Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated.<bold>Results: </bold>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.<bold>Limitation: </bold>Limited sample size.<bold>Conclusion: </bold>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.<bold>Primary Funding Source: </bold>University Medical Center Hamburg-Eppendorf.
- Subjects
GERMANY; UNIVERSITATSKLINIKUM Hamburg-Eppendorf; COVID-19; PULMONARY embolism; CORONARY disease; SARS-CoV-2; VENOUS thrombosis; AUTOPSY; VIRAL pneumonia; CAUSES of death; RESEARCH; VEINS; RESEARCH methodology; EVALUATION research; MEDICAL cooperation; COMPARATIVE studies; THROMBOEMBOLISM; EPIDEMICS; COMPUTED tomography; LONGITUDINAL method
- Publication
Annals of Internal Medicine, 2020, Vol 173, Issue 4, p268
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M20-2003