Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course
BackgroundAutopsies can shed light on the pathogenesis of new and emerging diseases.AimTo describe needle core necropsy findings of the lung, heart, and liver in decedents with COVID-19.MaterialCross-sectional study of needle core necropsies in patients who died with virologically confirmed COVID-19...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-07-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.874307/full |
| _version_ | 1818113222257934336 |
|---|---|
| author | Jose-Manuel Ramos-Rincon Jose-Manuel Ramos-Rincon Cristian Herrera-García Sandra Silva-Ortega Julia Portilla-Tamarit Cristina Alenda Cristina Alenda Francisco-Angel Jaime-Sanchez Francisco-Angel Jaime-Sanchez Juan Arenas-Jiménez Juan Arenas-Jiménez Francisca-Eugenia Fornés-Riera Alexander Scholz Isabel Escribano Víctor Pedrero-Castillo Carlos Muñoz-Miguelsanz Pedro Orts-Llinares Ana Martí-Pastor Antonio Amo-Lozano Raquel García-Sevila Isabel Ribes-Mengual Oscar Moreno-Perez Oscar Moreno-Perez Luis Concepcion-Aramendía Esperanza Merino Rosario Sánchez-Martínez Rosario Sánchez-Martínez Ignacio Aranda |
| author_facet | Jose-Manuel Ramos-Rincon Jose-Manuel Ramos-Rincon Cristian Herrera-García Sandra Silva-Ortega Julia Portilla-Tamarit Cristina Alenda Cristina Alenda Francisco-Angel Jaime-Sanchez Francisco-Angel Jaime-Sanchez Juan Arenas-Jiménez Juan Arenas-Jiménez Francisca-Eugenia Fornés-Riera Alexander Scholz Isabel Escribano Víctor Pedrero-Castillo Carlos Muñoz-Miguelsanz Pedro Orts-Llinares Ana Martí-Pastor Antonio Amo-Lozano Raquel García-Sevila Isabel Ribes-Mengual Oscar Moreno-Perez Oscar Moreno-Perez Luis Concepcion-Aramendía Esperanza Merino Rosario Sánchez-Martínez Rosario Sánchez-Martínez Ignacio Aranda |
| author_sort | Jose-Manuel Ramos-Rincon |
| collection | DOAJ |
| description | BackgroundAutopsies can shed light on the pathogenesis of new and emerging diseases.AimTo describe needle core necropsy findings of the lung, heart, and liver in decedents with COVID-19.MaterialCross-sectional study of needle core necropsies in patients who died with virologically confirmed COVID-19. Histopathological analyses were performed, and clinical data and patient course evaluated.ResultsChest core necropsies were performed in 71 decedents with a median age of 81 years (range 52–97); 47 (65.3%) were men. The median interval from symptoms onset to death was 17.5 days (range 1–84). Samples of lung (n = 62, 87.3%), heart (n = 48, 67.6%) and liver (n = 39, 54.9%) were obtained. Fifty-one lung samples (82.3%) were abnormal: 19 (30.6%) showed proliferative diffuse alveolar damage (DAD), 12 (19.4%) presented exudative DAD, and 10 (16.1%) exhibited proliferative plus exudative DAD. Of the 46 lung samples tested for SARS-CoV-19 by RT-PCR, 39 (84.8%) were positive. DAD was associated with premortem values of lactate dehydrogenase of 400 U/L or higher [adjusted odds ratio (AOR) 21.73; 95% confidence interval (CI) 3.22–146] and treatment with tocilizumab (AOR 6.91; 95% CI 1.14–41.7). Proliferative DAD was associated with an onset-to-death interval of over 15 days (AOR 7.85, 95% CI 1.29–47.80). Twenty-three of the 48 (47.9%) heart samples were abnormal: all showed fiber hypertrophy, while 9 (18.8%) presented fibrosis. Of the liver samples, 29/39 (74.4%) were abnormal, due to steatosis (n = 12, 30.8%), cholestasis (n = 6, 15.4%) and lobular central necrosis (n = 5, 12.8%).ConclusionProliferative DAD was the main finding on lung core needle necropsy in people who died from COVID-19; this finding was related to a longer disease course. Changes in the liver and heart were common. |
| first_indexed | 2024-12-11T03:31:24Z |
| format | Article |
| id | doaj.art-2e8a7550603042a4bf1437734442bb83 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-11T03:31:24Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-2e8a7550603042a4bf1437734442bb832022-12-22T01:22:22ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-07-01910.3389/fmed.2022.874307874307Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease CourseJose-Manuel Ramos-Rincon0Jose-Manuel Ramos-Rincon1Cristian Herrera-García2Sandra Silva-Ortega3Julia Portilla-Tamarit4Cristina Alenda5Cristina Alenda6Francisco-Angel Jaime-Sanchez7Francisco-Angel Jaime-Sanchez8Juan Arenas-Jiménez9Juan Arenas-Jiménez10Francisca-Eugenia Fornés-Riera11Alexander Scholz12Isabel Escribano13Víctor Pedrero-Castillo14Carlos Muñoz-Miguelsanz15Pedro Orts-Llinares16Ana Martí-Pastor17Antonio Amo-Lozano18Raquel García-Sevila19Isabel Ribes-Mengual20Oscar Moreno-Perez21Oscar Moreno-Perez22Luis Concepcion-Aramendía23Esperanza Merino24Rosario Sánchez-Martínez25Rosario Sánchez-Martínez26Ignacio Aranda27Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainClinical Medicine Department, Miguel Hernandez University of Elche, Elche, SpainInternal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainPathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainInternal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainPathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainPathology and Surgery Department, Miguel Hernández University of Elche, Elche, SpainClinical Medicine Department, Miguel Hernandez University of Elche, Elche, SpainIntensive Care Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainPathology and Surgery Department, Miguel Hernández University of Elche, Elche, SpainRadiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainAnesthesiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainInternal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainMicrobiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainPathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainAnesthesiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainIntensive Care Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainInternal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainInternal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainPneumology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainInternal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainClinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain0Endocrinology and Nutrition Department, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainRadiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain1Infectious Diseases Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainInternal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainClinical Medicine Department, Miguel Hernandez University of Elche, Elche, SpainPathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, SpainBackgroundAutopsies can shed light on the pathogenesis of new and emerging diseases.AimTo describe needle core necropsy findings of the lung, heart, and liver in decedents with COVID-19.MaterialCross-sectional study of needle core necropsies in patients who died with virologically confirmed COVID-19. Histopathological analyses were performed, and clinical data and patient course evaluated.ResultsChest core necropsies were performed in 71 decedents with a median age of 81 years (range 52–97); 47 (65.3%) were men. The median interval from symptoms onset to death was 17.5 days (range 1–84). Samples of lung (n = 62, 87.3%), heart (n = 48, 67.6%) and liver (n = 39, 54.9%) were obtained. Fifty-one lung samples (82.3%) were abnormal: 19 (30.6%) showed proliferative diffuse alveolar damage (DAD), 12 (19.4%) presented exudative DAD, and 10 (16.1%) exhibited proliferative plus exudative DAD. Of the 46 lung samples tested for SARS-CoV-19 by RT-PCR, 39 (84.8%) were positive. DAD was associated with premortem values of lactate dehydrogenase of 400 U/L or higher [adjusted odds ratio (AOR) 21.73; 95% confidence interval (CI) 3.22–146] and treatment with tocilizumab (AOR 6.91; 95% CI 1.14–41.7). Proliferative DAD was associated with an onset-to-death interval of over 15 days (AOR 7.85, 95% CI 1.29–47.80). Twenty-three of the 48 (47.9%) heart samples were abnormal: all showed fiber hypertrophy, while 9 (18.8%) presented fibrosis. Of the liver samples, 29/39 (74.4%) were abnormal, due to steatosis (n = 12, 30.8%), cholestasis (n = 6, 15.4%) and lobular central necrosis (n = 5, 12.8%).ConclusionProliferative DAD was the main finding on lung core needle necropsy in people who died from COVID-19; this finding was related to a longer disease course. Changes in the liver and heart were common.https://www.frontiersin.org/articles/10.3389/fmed.2022.874307/fullautopsypathologySARS-CoV-2coronavirusCOVID-19 |
| spellingShingle | Jose-Manuel Ramos-Rincon Jose-Manuel Ramos-Rincon Cristian Herrera-García Sandra Silva-Ortega Julia Portilla-Tamarit Cristina Alenda Cristina Alenda Francisco-Angel Jaime-Sanchez Francisco-Angel Jaime-Sanchez Juan Arenas-Jiménez Juan Arenas-Jiménez Francisca-Eugenia Fornés-Riera Alexander Scholz Isabel Escribano Víctor Pedrero-Castillo Carlos Muñoz-Miguelsanz Pedro Orts-Llinares Ana Martí-Pastor Antonio Amo-Lozano Raquel García-Sevila Isabel Ribes-Mengual Oscar Moreno-Perez Oscar Moreno-Perez Luis Concepcion-Aramendía Esperanza Merino Rosario Sánchez-Martínez Rosario Sánchez-Martínez Ignacio Aranda Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course Frontiers in Medicine autopsy pathology SARS-CoV-2 coronavirus COVID-19 |
| title | Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course |
| title_full | Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course |
| title_fullStr | Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course |
| title_full_unstemmed | Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course |
| title_short | Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course |
| title_sort | pathological findings associated with sars cov 2 on postmortem core biopsies correlation with clinical presentation and disease course |
| topic | autopsy pathology SARS-CoV-2 coronavirus COVID-19 |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.874307/full |
| work_keys_str_mv | AT josemanuelramosrincon pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT josemanuelramosrincon pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT cristianherreragarcia pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT sandrasilvaortega pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT juliaportillatamarit pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT cristinaalenda pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT cristinaalenda pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT franciscoangeljaimesanchez pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT franciscoangeljaimesanchez pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT juanarenasjimenez pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT juanarenasjimenez pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT franciscaeugeniafornesriera pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT alexanderscholz pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT isabelescribano pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT victorpedrerocastillo pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT carlosmunozmiguelsanz pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT pedroortsllinares pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT anamartipastor pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT antonioamolozano pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT raquelgarciasevila pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT isabelribesmengual pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT oscarmorenoperez pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT oscarmorenoperez pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT luisconcepcionaramendia pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT esperanzamerino pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT rosariosanchezmartinez pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT rosariosanchezmartinez pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse AT ignacioaranda pathologicalfindingsassociatedwithsarscov2onpostmortemcorebiopsiescorrelationwithclinicalpresentationanddiseasecourse |