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- Title
Clinicopathologic characteristics of severe COVID-19 patients in Mexico City: A post-mortem analysis using a minimally invasive autopsy approach.
- Authors
Nava-Santana, Carlos; Rodríguez-Armida, María; Jiménez, José Víctor; Vargas-Parra, Nancy; León, Diana E. Aguilar; Campos-Murguia, Alejandro; Macías-Rodriguez, Ricardo; Arteaga-Garrido, Andrés; Hernández-Villegas, Antonio C.; Dominguez-Cherit, Guillermo; Rivero-Sigarroa, Eduardo; Gamboa-Dominguez, Armando; Gullias-Herrero, Alfonso; Sifuentes-Osornio, José; Uribe-Uribe, Norma Ofelia; Morales-Buenrostro, Luis E.
- Abstract
Objective: Describe the histological findings of minimally ultrasound-guided invasive autopsies in deceased patients with severe SARS-CoV-2 and compare the diagnostic yield with open autopsies. Design: Observational post-mortem cohort study. Minimally invasive ultrasound-guided autopsies were performed in fourteen deceased patients with a confirmed diagnosis of SARS-CoV-2 pneumonia. Histological and clinical findings of lung, kidney, and liver tissue are described and contrasted with those previously reported in the literature. Setting: Single-center COVID-19 reference center in Mexico City. Results: Fourteen minimally invasive autopsies revealed a gross correlation with open autopsies reports: 1) Lung histology was characterized mainly by early diffuse alveolar damage (12/13). Despite low lung compliances and prolonged mechanical ventilation, the fibrotic phase was rarely observed (2/13). 2) Kidney histopathology demonstrated acute tubular injury (12/13), interstitial nephritis (11/13), and glomerulitis (11/13) as the predominant features 3) Liver histology was characterized by neutrophilic inflammation in all of the cases, as well as hepatic necrosis (8/14) despite minimal alterations in liver function testing. Hepatic steatosis was observed in most cases (12/14). SARS-CoV-2 positivity was widely observed throughout the immunohistochemical analysis. However, endothelitis and micro thrombosis, two of the hallmark features of the disease, were not observed. Conclusion: Our data represents the largest minimally invasive, ultrasound-guided autopsy report. We demonstrate a gross histological correlation with large open autopsy cohorts. However, this approach might overlook major histologic features of the disease, such as endothelitis and micro-thrombosis. Whether this represents sampling bias is unclear.
- Subjects
MEXICO City (Mexico); COVID-19; AUTOPSY; CLINICAL pathology; LIVER histology; INTERSTITIAL nephritis; LIVER function tests
- Publication
PLoS ONE, 2022, Vol 17, Issue 3, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0262783