Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA, USA; Pathology and Laboratory Medicine Service, Southeast Louisiana Veterans Healthcare System, New Orleans, LA, USA.
Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Lancet Respir Med. 2020 Jul;8(7):681-686. doi: 10.1016/S2213-2600(20)30243-5. Epub 2020 May 27.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly across the USA, causing extensive morbidity and mortality, particularly in the African American community. Autopsy can considerably contribute to our understanding of many disease processes and could provide crucial information to guide management of patients with coronavirus disease 2019 (COVID-19). We report on the relevant cardiopulmonary findings in, to our knowledge, the first autopsy series of ten African American decedents, with the cause of death attributed to COVID-19.
Autopsies were performed on ten African American decedents aged 44-78 years with cause of death attributed to COVID-19, reflective of the dominant demographic of deaths following COVID-19 diagnosis in New Orleans. Autopsies were done with consent of the decedents' next of kin. Pulmonary and cardiac features were examined, with relevant immunostains to characterise the inflammatory response, and RNA labelling and electron microscopy on representative sections.
Important findings include the presence of thrombosis and microangiopathy in the small vessels and capillaries of the lungs, with associated haemorrhage, that significantly contributed to death. Features of diffuse alveolar damage, including hyaline membranes, were present, even in patients who had not been ventilated. Cardiac findings included individual cell necrosis without lymphocytic myocarditis. There was no evidence of secondary pulmonary infection by microorganisms.
We identify key pathological states, including thrombotic and microangiopathic pathology in the lungs, that contributed to death in patients with severe COVID-19 and decompensation in this demographic. Management of these patients should include treatment to target these pathological mechanisms.
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严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）在美国迅速传播，造成广泛的发病率和死亡率，尤其是在非裔美国人社区。尸检可以极大地帮助我们了解许多疾病过程，并为管理 2019 年冠状病毒病（COVID-19）患者提供关键信息。我们报告了十名非裔美国人死者的相关心肺发现，据我们所知，这是 COVID-19 死亡归因的首例尸检系列。
对十名年龄在 44-78 岁的非裔美国人死者进行了尸检，其死因归因于 COVID-19，反映了新奥尔良 COVID-19 诊断后死亡的主要人群。尸检是在死者近亲同意的情况下进行的。检查了肺部和心脏特征，进行了相关免疫组化以表征炎症反应，并对代表性切片进行了 RNA 标记和电子显微镜检查。
重要发现包括肺中小血管和毛细血管中的血栓形成和微血管病，伴有相关出血，这对死亡有重要影响。弥漫性肺泡损伤的特征，包括透明膜，甚至在未通气的患者中也存在。心脏发现包括单个细胞坏死而无淋巴细胞性心肌炎。没有证据表明微生物引起的继发性肺部感染。
我们确定了关键的病理状态，包括肺部的血栓形成和微血管病，这些病理状态导致了严重 COVID-19 患者和该人群中失代偿的死亡。这些患者的治疗应包括针对这些病理机制的治疗。
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