Postmortem examination of COVID‐19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction

Histopathology - Tập 77 Số 2 - Trang 198-209 - 2020
Thomas Menter1, Jasmin D. Haslbauer1, Ronny Nienhold2, Spasenija Savic1, Helmut Hopfer1, Nikolaus Deigendesch1, Stephan Frank1, Daniel Turek2, Niels Willi2, Hans Pargger3, Stefano Bassetti4, Jörg D. Leuppi5, Gieri Cathomas2, Markus Tolnay1, Kirsten D. Mertz2, Alexandar Tzankov1
1Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
2Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
3Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
4Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
5University Department of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland

Tóm tắt

AimsCoronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has rapidly evolved into a sweeping pandemic. Its major manifestation is in the respiratory tract, and the general extent of organ involvement and the microscopic changes in the lungs remain insufficiently characterised. Autopsies are essential to elucidate COVID‐19‐associated organ alterations.Methods and resultsThis article reports the autopsy findings of 21 COVID‐19 patients hospitalised at the University Hospital Basel and at the Cantonal Hospital Baselland, Switzerland. An in‐corpore technique was performed to ensure optimal staff safety. The primary cause of death was respiratory failure with exudative diffuse alveolar damage and massive capillary congestion, often accompanied by microthrombi despite anticoagulation. Ten cases showed superimposed bronchopneumonia. Further findings included pulmonary embolism (n = 4), alveolar haemorrhage (n = 3), and vasculitis (n = 1). Pathologies in other organ systems were predominantly attributable to shock; three patients showed signs of generalised and five of pulmonary thrombotic microangiopathy. Six patients were diagnosed with senile cardiac amyloidosis upon autopsy. Most patients suffered from one or more comorbidities (hypertension, obesity, cardiovascular diseases, and diabetes mellitus). Additionally, there was an overall predominance of males and individuals with blood group A (81% and 65%, respectively). All relevant histological slides are linked as open‐source scans in supplementary files.ConclusionsThis study provides an overview of postmortem findings in COVID‐19 cases, implying that hypertensive, elderly, obese, male individuals with severe cardiovascular comorbidities as well as those with blood group A may have a lower threshold of tolerance for COVID‐19. This provides a pathophysiological explanation for higher mortality rates among these patients.

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Tài liệu tham khảo

Monto AS, 1974, Medical reviews. Coronaviruses, Yale J. Biol. Med., 47, 234

10.1001/archpedi.1985.02140110082036

10.1056/NEJMoa030747

10.1056/NEJMoa1211721

10.1002/ame2.12017

COVID‐19 Situation update worldwide.European Centre for Disease Prevention and Control. Available at:https://www.ecdc.europa.eu/en/geographical‐distribution‐2019‐ncov‐cases(accessed 23 April 2020).

10.1016/j.tmaid.2020.101623

10.1016/j.jtho.2020.02.010

10.1016/S2213-2600(20)30076-X

10.1016/j.tmaid.2020.101665

10.1093/ajcp/aqaa062

Tian S, 2020, Pathological study of the 2019 novel coronavirus disease (COVID‐19) through postmortem core biopsies, Mod. Pathol., 14, 1

Magro C, 2020, Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID‐19 infection: a report of five cases, Transl. Res., 1931, 30070

10.1002/path.1440

10.1084/jem.20050828

10.1016/S0046-8177(03)00367-8

10.1038/modpathol.3800247

10.1016/j.virusres.2007.01.022

10.3390/v12020244

10.1016/j.ajpath.2015.10.024

10.1111/his.13379

10.1136/jclinpath-2020-206522

10.1159/000447304

Ehmann MA, 2020, Histologic features of hematopoietic stem cell transplant‐associated thrombotic microangiopathy are best percepted in deep skin biopsies and renal biopsies, while showing a significant overlap with changes related to severe acute graft‐versus‐host disease in gastrointestinal biopsies, Bone Marrow Transplant

10.1097/PAI.0000000000000751

Blood group distribution in Switzerland.Swiss transfusion SRC. Available at:https://www.blutspende.ch/de/wissen‐ueber‐blut/blutgruppen(accessed 23 April 2020).

Emami A, 2020, Prevalence of underlying diseases in hospitalized patients with COVID‐19: a systematic review and meta‐analysis, Arch. Acad. Emerg. Med., 8, e35

10.1136/bmj.m1091

10.1038/nrmicro2147

10.3201/eid1002.030913

10.1038/s41586-020-2196-x

10.1016/S0140-6736(20)30937-5

10.1016/j.kint.2020.04.003

Kissling S, 2020, Collapsing glomerulopathy in a COVID‐19 patient, Kidney Int., 0085, 30369

10.1111/jth.14768

10.3109/13506129.2012.685131

10.1016/j.cardiores.2004.11.013

10.1016/j.kint.2020.03.005

Zhao J, 2020, Relationship between the ABO blood group and the COVID‐19 susceptibility (pre‐print, not peer‐reviewed), medRxiv

10.1111/j.1537-2995.2006.00975.x

10.1160/TH06-09-0549

10.1160/TH04-04-0251

10.1160/TH14-05-0457

10.1093/glycob/cwn093

10.1016/j.cell.2020.02.052

10.1007/s00134-020-05985-9

10.1093/eurheartj/ehaa235

10.1161/CIRCRESAHA.120.317134

10.1016/S0140-6736(20)30183-5

10.1016/j.jaut.2020.102452

10.1128/mBio.01753-18

10.1161/CIRCULATIONAHA.120.047419

Eculizumab (Soliris) in Covid‐19 infected patients (SOLID‐C19). ClinicalTrials.gov. Available at:https://clinicaltrials.gov/ct2/show/NCT04288713(accessed 23 April 2020).

10.1182/asheducation-2018.1.539

Wu Y, 2020, Nervous system involvement after infection with COVID‐19 and other coronaviruses, Brain Behav. Immun., 0889, 30357

10.1183/13993003.00524-2020

10.1007/s00392-020-01626-9

10.1016/j.dsx.2020.03.016

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Histopathology

Tập 77 Số 2

198-209

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