Cause of death based on systematic post-mortem studies in patients with positive SARS-CoV-2 tissue PCR during the COVID-19 pandemic.

Autor: Romanova ES; From the, Department of Infectious Diseases, Mechnikov North-Western State Medical University, St. Petersburg, Russia., Vasilyev VV; From the, Department of Infectious Diseases, Mechnikov North-Western State Medical University, St. Petersburg, Russia., Startseva G; From the, Department of Infectious Diseases, Mechnikov North-Western State Medical University, St. Petersburg, Russia., Karev V; Pediatric Research and Clinical Center for Infectious Diseases, St. Petersburg, Russia., Rybakova MG; Department of Pathology, Pavlov First St. Petersburg Medical University, St. Petersburg, Russia., Platonov PG; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
Jazyk: angličtina
Zdroj: Journal of internal medicine [J Intern Med] 2021 Sep; Vol. 290 (3), pp. 655-665. Date of Electronic Publication: 2021 May 20.
DOI: 10.1111/joim.13300
Abstrakt: Importance: Assessment of the causative association between the COVID-19 and cause of death has been hampered by limited availability of systematically performed autopsies. We aimed to present autopsy-confirmed causes of death in patients who died with COVID-19 and to assess the association between thrombosis and diffuse alveolar damage consistent with COVID-19 (DAD).
Methods: Consecutive forensic (n = 60) and clinical (n = 42) autopsies with positive post-mortem SARS-CoV-2 PCR in lungs (age 73 ± 14 years, 50% men) were included. The cause of death analysis was based on a review of medical records and histological reports. Thrombotic phenomena in lungs were defined as pulmonary thromboembolism (PE), thrombosis in pulmonary artery branches or microangiopathy in capillary vessels.
Results: COVID-19 caused or contributed to death in 71% of clinical and 83% of forensic autopsies, in whom significant DAD was observed. Of the patients with COVID-19 as the primary cause of death, only 19% had no thrombotic phenomena in the lungs, as opposed to 38% amongst those with COVID-19 as a contributing cause of death and 54% amongst patients whose death was not related to COVID-19 (p = 0.002). PE was observed in 5 patients. Two patients fulfilled the criteria for lymphocyte myocarditis.
Conclusions: Vast majority of all PCR-positive fatalities, including out-of-hospital deaths, during the SARS-CoV-2 pandemic were related to DAD caused by COVID-19. Pulmonary artery thrombosis and microangiopathy in pulmonary tissue were common and associated with the presence of DAD, whilst venous PE was rarely observed. Histology-confirmed lymphocyte myocarditis was a rare finding.
(© 2021 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)
Databáze: MEDLINE
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