08.05.2020
Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study
Others Transversal
Wichmann D et al
Ann Intern Med
Main result
12 autopsies of patients infected with CoV-2-SARS: median age 73 years, 75% male, and all had at least one pre-existing co-morbidity.
Postmortem CT scan (n=10) shows consolidation of bilateral dense pulmonary infiltrates with pre- and post-mortem lesions.
At autopsy: 4 deaths caused by massive pulmonary embolisms were identified and overall vascular thromboses were frequently found at different anatomical sites (lower limbs or peri-prostatic). The lungs all presented lesions of severe pneumopathies (congestion, increased weight, pleural effusion). Almost all patients also had heart disease.
Histology revealed the presence of hyaline membranes, activated pneumocytes, microemboli, interstitial edema, inflammatory infiltrates, and later stages of squamous metaplasia, destruction of alveolar walls, and lymphocytic infiltration of the bronchi.
Virological tests detected the presence of SARS-CoV-2 RNA in the lungs in 100% of cases and in 75% of cases in the pharynx. 50% of patients had moderate viremia (<4 × 104 copies/ml) with detections in other tissues (heart, liver, or kidney) at concentrations exceeding viremia. 25% of patients had detectable viral RNA in the brain and saphenous vein.
Postmortem CT scan (n=10) shows consolidation of bilateral dense pulmonary infiltrates with pre- and post-mortem lesions.
At autopsy: 4 deaths caused by massive pulmonary embolisms were identified and overall vascular thromboses were frequently found at different anatomical sites (lower limbs or peri-prostatic). The lungs all presented lesions of severe pneumopathies (congestion, increased weight, pleural effusion). Almost all patients also had heart disease.
Histology revealed the presence of hyaline membranes, activated pneumocytes, microemboli, interstitial edema, inflammatory infiltrates, and later stages of squamous metaplasia, destruction of alveolar walls, and lymphocytic infiltration of the bronchi.
Virological tests detected the presence of SARS-CoV-2 RNA in the lungs in 100% of cases and in 75% of cases in the pharynx. 50% of patients had moderate viremia (<4 × 104 copies/ml) with detections in other tissues (heart, liver, or kidney) at concentrations exceeding viremia. 25% of patients had detectable viral RNA in the brain and saphenous vein.
Takeaways
- The clinical data for COVID-19 are consistent with those reported in autopsies of patients who died from the infection: bilateral pulmonary infiltrates and thromboembolic diseases found in the 12 autopsies performed.
- Even postmortem and at least up to 5 days after death, the SARS-CoV-2 RNA remains detectable with moderate viremia in the lungs (100% of cases). It is also frequently found in the pharynx and sometimes in the heart, liver or kidneys.
Strength of evidence Moderate
Cohort study with prospective, consecutive and systematic recruitment of all patients with confirmed SARS-CoV-2 infection
- Satisfactory autopsy protocol and good virological tests
- Consistent results
- But low numbers (n=12)
- No evidence of the infectious risk represented by this moderate post-mortem viremia.
Objectives
Validate and compare COVID-19 clinical data with medical autopsy, virtual autopsy, and virological test data.
Method
- Prospective, consecutive, and comprehensive cohort study with autopsies of all patients who died in the Hamburg area who had previously tested positive for CoV-2-SARS by PCR.
- Postmortem whole-body CT scan performed prior to full autopsy, with the necessary protective measures in place
- The time between examination and death ranged from 1 to 5 days.
- Multiple organ harvesting for histological purposes with 4% formalin fixation and HES staining
- Virological tests by PCR performed on cardiac, pulmonary, hepatic, renal, pharyngeal, superficial vein, and venous peripheral blood samples.
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