Salerno Monica, Sessa Francesco, Piscopo Amalia, Montana Angelo, Torrisi Marco, Patanè Federico, Murabito Paolo, Volti Giovanni Li, Pomara Cristoforo
Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, 95121 Catania, Italy.
Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
J Clin Med. 2020 May 14;9(5):1472. doi: 10.3390/jcm9051472.
The current outbreak of COVID-19 infection, which started in Wuhan, Hubei province, China, in December 2019, is an ongoing challenge and a significant threat to public health requiring surveillance, prompt diagnosis, and research efforts to understand a new, emergent, and unknown pathogen and to develop effective therapies. Despite the increasing number of published studies on COVID-19, in all the examined studies the lack of a well-defined pathophysiology of death among patients who died following COVID-19 infection is evident. Autopsy should be considered mandatory to define the exact cause of death, thus providing useful clinical and epidemiologic information as well as pathophysiological insights to further provide therapeutic tools.
A literature review was performed on PubMed database, using the key terms: "COVID-19", "nCov 19", and "Sars Cov 2". 9709 articles were retrieved; by excluding all duplicated articles, additional criteria were then applied: articles or abstracts in English and articles containing one of the following words: "death", "died", "comorbidity", "cause of death", "biopsy", "autopsy", or "pathological".
A total of 50 articles met the inclusion criteria. However, only 7 of these studies reported autopsy-based data.
The analysis of the main data from the selected studies concerns the complete analysis of 12,954 patients, of whom 2269 died (with a mortality rate of 17.52%). Laboratory confirmation of COVID-19 infection was obtained in all cases and comorbidities were fully reported in 46 studies. The most common comorbidities were: cardiovascular diseases (hypertension and coronary artery disease), metabolic disorders (diabetes, overweight, or obesity), respiratory disorders (chronic obstructive pulmonary disease), and cancer. The most common reported complications were: acute respiratory distress syndrome (ARDS), acute kidney injury, cardiac injury, liver insufficiency, and septic shock. Only 7 papers reported histological investigations. Nevertheless, only two complete autopsies are described and the cause of death was listed as COVID-19 in only one of them. The lack of postmortem investigation did not allow a definition of the exact cause of death to determine the pathways of this infection. Based on the few histopathological findings reported in the analyzed studies, it seems to be a clear alteration of the coagulation system: frequently prothrombotic activity with consequent thromboembolism was described in COVID-19 patients. As a scientific community, we are called on to face this global threat, and to defeat it with all the available tools necessary. Despite the improvement and reinforcement of any method of study in every field of medicine and science, encouraging the autopsy practice as a tool of investigation could also therefore, help physicians to define an effective treatment to reduce mortality.
2019年12月在中国湖北省武汉市爆发的新型冠状病毒肺炎（COVID-19）疫情，是一项持续的挑战，对公共卫生构成重大威胁，需要进行监测、及时诊断，并开展研究工作，以了解一种新出现的未知病原体，并开发有效的治疗方法。尽管关于COVID-19的已发表研究数量不断增加，但在所有已审查的研究中，COVID-19感染后死亡患者缺乏明确的死亡病理生理学这一点很明显。应强制进行尸检以确定确切死因，从而提供有用的临床和流行病学信息以及病理生理学见解，以进一步提供治疗工具。
在PubMed数据库上进行文献综述，使用关键词：“COVID-19”、“nCov 19”和“Sars Cov 2”。检索到9709篇文章；通过排除所有重复文章，然后应用其他标准：英文文章或摘要，以及包含以下任何一个词的文章：“死亡”、“死亡”、“合并症”、“死因”、“活检”、“尸检”或“病理”。
共有50篇文章符合纳入标准。然而，这些研究中只有7篇报告了基于尸检的数据。
对所选研究的主要数据进行分析，涉及对12954例患者的全面分析，其中2269例死亡（死亡率为17.52%）。所有病例均获得COVID-19感染的实验室确诊，46项研究充分报告了合并症。最常见的合并症是：心血管疾病（高血压和冠状动脉疾病）、代谢紊乱（糖尿病、超重或肥胖）、呼吸系统疾病（慢性阻塞性肺疾病）和癌症。报告的最常见并发症是：急性呼吸窘迫综合征（ARDS）、急性肾损伤、心脏损伤、肝功能不全和感染性休克。只有7篇论文报告了组织学研究。然而，仅描述了两例完整的尸检，其中只有一例将死因列为COVID-19。缺乏死后调查无法确定确切死因，以确定这种感染的途径。根据分析研究中报告的少数组织病理学发现，似乎凝血系统有明显改变：COVID-19患者中经常描述有促血栓形成活性，继而发生血栓栓塞。作为一个科学界，我们被要求面对这一全球威胁，并使用所有必要的可用工具战胜它。尽管医学和科学各个领域的任何研究方法都在改进和加强，但鼓励将尸检作为一种调查工具，因此也可以帮助医生确定有效的治疗方法以降低死亡率。
