Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, Florence 50134, Italy; Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00147, Italy.
Leg Med (Tokyo). 2023 May;62:102241. doi: 10.1016/j.legalmed.2023.102241. Epub 2023 Mar 12.
Autopsies in SARS-CoV-2 infected cadavers are mainly performed to distinguish patients who died with SARS-CoV-2 infection from those who died of COVID-19. The aim of the current study is to assess the most frequent autopsy findings in patients who died of COVID-19 and to establish an association with clinical records.
60 patients died between April 2020 and March 2021 after SARS-CoV-2 infection underwent a full autopsy performed at Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome). Ante-mortem diagnosis of SARS-CoV-2 infection was microbiologically confirmed.
55 (92%) of cases had at least a comorbidity. At microscopic examination, 40 (67%) of the patients presented pulmonary intravascular coagulation with an inflammatory pattern. Pulmonary microangiopathy was a rare finding (n = 8; 13%). Myocardiosclerosis was the main heart finding (n = 44; 73%). Liver involvement with congestion and hypotrophy was found in 33 (55%) of cadavers. Renal tubular epithelial exfoliation (n = 12; 20%) and intravascular coagulation (n = 4; 7%) were frequent observations. During hospitalization 31% of patients (n = 19) developed acute kidney injury (AKI).
Lungs and kidneys have been shown to play a pivotal role in COVID-19. The gradual worsening of renal function and AKI might be the result of the progressive collapse of cardiopulmonary system.
对感染 SARS-CoV-2 的尸体进行尸检主要是为了区分死于 SARS-CoV-2 感染的患者和死于 COVID-19 的患者。本研究的目的是评估死于 COVID-19 的患者中最常见的尸检发现，并与临床记录建立关联。
2020 年 4 月至 2021 年 3 月期间，在 Fondazione Policlinico Universitario Agostino Gemelli IRCCS（罗马）对 60 名因 SARS-CoV-2 感染而死亡的患者进行了全面尸检。SARS-CoV-2 感染的生前诊断通过微生物学确认。
55 例（92%）患者至少有一种合并症。在显微镜检查中，40 例（67%）患者表现出伴有炎症模式的肺血管内凝血。肺微血管病是一种罕见的发现（n=8；13%）。心肌硬化是心脏的主要发现（n=44；73%）。33 例（55%）尸体的肝脏有充血和萎缩的改变。12 例（20%）和 4 例（7%）的肾脏发现肾小管上皮脱落和血管内凝血。住院期间，31%的患者（n=19）发生急性肾损伤（AKI）。
肺和肾脏在 COVID-19 中起着关键作用。肾功能和 AKI 的逐渐恶化可能是心肺系统逐渐崩溃的结果。
