Septimiu-Radu Susa, Gadela Tejaswi, Gabriela Doros, Oancea Cristian, Rosca Ovidiu, Lazureanu Voichita Elena, Fericean Roxana Manuela, Bratosin Felix, Dumitrescu Andreea, Stoicescu Emil Robert, Bagiu Iulia, Murariu Mircea, Mavrea Adelina
Department XIII, Discipline of Infectious Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Doctoral School, ''Victor Babes'' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
J Clin Med. 2023 Mar 6;12(5):2070. doi: 10.3390/jcm12052070.
Although COVID-19 may cause various and multiorgan diseases, few research studies have examined the postmortem pathological findings of SARS-CoV-2-infected individuals who died. Active autopsy results may be crucial for understanding how COVID-19 infection operates and preventing severe effects. In contrast to younger persons, however, the patient's age, lifestyle, and concomitant comorbidities might alter the morpho-pathological aspects of the damaged lungs. Through a systematic analysis of the available literature until December 2022, we aimed to provide a thorough picture of the histopathological characteristics of the lungs in patients older than 70 years who died of COVID-19. A thorough search was conducted on three electronic databases (PubMed, Scopus, and Web of Science), including 18 studies and a total of 478 autopsies performed. It was observed that the average age of patients was 75.6 years, of which 65.4% were men. COPD was identified in an average of 16.7% of all patients. Autopsy findings indicated significantly heavier lungs, with an average weight of the right lung of 1103 g, while the left lung mass had an average weight of 848 g. Diffuse alveolar damage was a main finding in 67.2% of all autopsies, while pulmonary edema had a prevalence of between 50% and 70%. Thrombosis was also a significant finding, while some studies described focal and extensive pulmonary infarctions in 72.7% of elderly patients. Pneumonia and bronchopneumonia were observed, with a prevalence ranging from 47.6% to 89.5%. Other important findings described in less detail comprise hyaline membranes, the proliferation of pneumocytes and fibroblasts, extensive suppurative bronchopneumonic infiltrates, intra-alveolar edema, thickened alveolar septa, desquamation of pneumocytes, alveolar infiltrates, multinucleated giant cells, and intranuclear inclusion bodies. These findings should be corroborated with children's and adults' autopsies. Postmortem examination as a technique for studying the microscopic and macroscopic features of the lungs might lead to a better knowledge of COVID-19 pathogenesis, diagnosis, and treatment, hence enhancing elderly patient care.
尽管新冠病毒可能引发多种多器官疾病，但针对死于新冠病毒感染个体的尸检病理结果的研究较少。尸检结果对于理解新冠病毒感染机制及预防严重后果可能至关重要。然而，与年轻人相比，患者的年龄、生活方式及合并症可能会改变受损肺部的形态病理特征。通过对截至2022年12月的现有文献进行系统分析，我们旨在全面呈现70岁以上死于新冠病毒患者肺部的组织病理学特征。我们在三个电子数据库（PubMed、Scopus和Web of Science）上进行了全面检索，共纳入18项研究，总计478例尸检。观察发现，患者的平均年龄为75.6岁，其中65.4%为男性。所有患者中平均16.7%被诊断患有慢性阻塞性肺疾病（COPD）。尸检结果显示肺部明显更重，右肺平均重量为1103克，左肺平均重量为848克。弥漫性肺泡损伤是67.2%的尸检中的主要发现，而肺水肿的发生率在50%至70%之间。血栓形成也是一个重要发现，一些研究描述了72.7%的老年患者出现局灶性和广泛性肺梗死。观察到肺炎和支气管肺炎，发生率在47.6%至89.5%之间。其他描述较少的重要发现包括透明膜、肺细胞和成纤维细胞增殖、广泛的化脓性支气管肺炎浸润、肺泡内水肿、肺泡间隔增厚、肺细胞脱屑、肺泡浸润、多核巨细胞和核内包涵体。这些发现应与儿童和成人的尸检结果相互印证。尸检作为研究肺部微观和宏观特征的技术，可能有助于更好地了解新冠病毒的发病机制、诊断和治疗，从而改善老年患者的护理。
