From the, Department of Infectious Diseases, Mechnikov North-Western State Medical University, St. Petersburg, Russia.
Pediatric Research and Clinical Center for Infectious Diseases, St. Petersburg, Russia.
J Intern Med. 2021 Sep;290(3):655-665. doi: 10.1111/joim.13300. Epub 2021 May 20.
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).
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.
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.
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.
由于系统进行的尸检有限，评估 COVID-19 与死亡原因之间的因果关系受到了阻碍。我们旨在展示死于 COVID-19 的患者的尸检证实的死亡原因，并评估与 COVID-19（DAD）一致的血栓形成和弥漫性肺泡损伤（DAD）之间的关联。
连续进行了 60 例法医（n=60）和 42 例临床（n=42）尸检，这些尸检的肺部均通过聚合酶链反应（PCR）检测出 SARS-CoV-2 呈阳性（年龄 73±14 岁，50%为男性）。死因分析基于对病历和组织学报告的审查。肺部的血栓形成现象定义为肺血栓栓塞症（PE）、肺动脉分支的血栓形成或毛细血管的微血管病。
COVID-19 导致或促成了 71%的临床尸检和 83%的法医尸检患者的死亡，这些患者中观察到明显的 DAD。在 COVID-19 是主要死亡原因的患者中，只有 19%的患者肺部没有血栓形成现象，而 COVID-19 是次要死亡原因的患者中有 38%，COVID-19 与死亡无关的患者中有 54%（p=0.002）。5 例患者观察到 PE。2 例患者符合淋巴细胞性心肌炎的标准。
在 SARS-CoV-2 大流行期间，绝大多数 PCR 阳性的死亡病例，包括院外死亡，都与 COVID-19 引起的 DAD 有关。肺组织中的肺动脉血栓形成和微血管病很常见，并且与 DAD 的存在有关，而静脉性 PE 很少观察到。组织学证实的淋巴细胞性心肌炎是一种罕见的发现。
