University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.).
Asklepios Hospital Barmbek, Hamburg, Germany (H.B., A.S.).
Ann Intern Med. 2020 Aug 18;173(4):268-277. doi: 10.7326/M20-2003. Epub 2020 May 6.
BACKGROUND: The new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features. OBJECTIVE: To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests. DESIGN: Prospective cohort study. SETTING: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction-confirmed diagnosis of COVID-19. PATIENTS: The first 12 consecutive COVID-19-positive deaths. MEASUREMENTS: Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. RESULTS: Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital ( = 10) or outpatient sector ( = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem computed tomography revealed reticular infiltration of the lungs with severe bilateral, dense consolidation, whereas histomorphologically diffuse alveolar damage was seen in 8 patients. In all patients, SARS-CoV-2 RNA was detected in the lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart. LIMITATION: Limited sample size. CONCLUSION: The high incidence of thromboembolic events suggests an important role of COVID-19-induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19-related death, as well as possible therapeutic interventions to reduce it. PRIMARY FUNDING SOURCE: University Medical Center Hamburg-Eppendorf.
背景：新型冠状病毒（SARS-CoV-2）已导致全球超过 21 万人死亡。然而，对于死亡原因以及该病毒的病理特征知之甚少。
目的：验证并比较临床发现与来自医学尸检、虚拟尸检和病毒学检测的数据。
设计：前瞻性队列研究。
设置：在德国汉堡州要求对经聚合酶链反应确诊为 COVID-19 的患者进行尸检的一家学术医疗中心进行尸检。
患者：前 12 例连续的 COVID-19 阳性死亡病例。
测量：进行了完整的尸检，包括死后计算机断层扫描以及组织病理学和病毒学分析。评估了临床数据和医疗经过。
结果：中位患者年龄为 73 岁（范围 52 岁至 87 岁），75%的患者为男性，死亡发生在医院（10 例）或门诊部门（2 例）。最常见的合并症为冠心病和哮喘或慢性阻塞性肺疾病（分别为 50%和 25%）。7 例（58%）患者在尸检中发现深静脉血栓，而在死亡前并未怀疑静脉血栓栓塞症；4 例患者的直接死因是肺栓塞。死后计算机断层扫描显示肺部有网状浸润，双侧严重致密实变，而 8 例患者组织形态学上表现为弥漫性肺泡损伤。所有患者的肺部均检测到 SARS-CoV-2 RNA 浓度较高；6 例（10 例中的 6 例）和 5 例（12 例中的 5 例）患者的血液、肝脏、肾脏或心脏中的病毒载量均较高。
局限性：样本量有限。
结论：血栓栓塞事件的高发生率表明 COVID-19 诱导的凝血功能障碍起重要作用。需要进一步研究以调查 COVID-19 相关死亡的分子机制和总体临床发生率，以及可能减少死亡的治疗干预措施。
主要资金来源：汉堡大学医学中心。
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