Bussani Rossana, Porcari Aldostefano, Pinamonti Maurizio, Iacobucci Anthea, Belladonna Eleonora, Tomasini Ariella, Zanconati Fabrizio, Collesi Chiara, Giacca Mauro, Berlot Giorgio, Sinagra Gianfranco, Silvestri Furio
Institute of Pathological Anatomy and Histology, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy.
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Eur J Clin Invest. 2025 Jan;55(1):e14325. doi: 10.1111/eci.14325. Epub 2024 Sep 29.
The contribution of SARS-CoV-2 infection on lung damage and the effect of vaccination on either containing the number of deaths or mitigating lung damage has not been systematically investigated.
Post-mortem analysis was performed among consecutive in-patients with COVID-19 deceased in the Province of Trieste (2020-2022). The outcomes of the study were (i) rates of in-hospital mortality, (ii) contribution of COVID-19 to death, (iii) histological extent of lung injury and (iv) impact of vaccination.
A total of 1038 consecutive hospitalized patients who died with SARS-CoV-2 infection were autopsied and deep histological analysis of the lungs was performed in a randomly selected sample of 508 cases. Among them, SARS-CoV-2 infection was (a) the cause of death (n = 90), (b) contributing to death (n = 304) and (c) an accompanying feature (n = 114). The incidence of SARS-CoV-2 infection as the primary cause of mortality decreased over time (23.8% in 2020, 20.9% in 2021 and 7.9% in 2022). On multivariable analysis, vaccination (any dose) was independently associated with lower rates of death related to SARS-CoV-2 infection (HR .15, p < .001), after adjusting for other independent predictors. A total of 172 patients were vaccinated at least with two doses at the time of death: 93% triple-vaccinated, 7% double-vaccinated. On histological analysis, vaccinated patients had a greater frequency of pneumonia severity score 0 and 1 (20.3% vs. 5.4% and 20.9% vs. 7.7%, p < .001, respectively), and a substantially lower proportion of pneumonia severity score 3 (26.2% vs. 55.1%, p < .001) compared to unvaccinated patients.
COVID-19 vaccination has substantially reduced rates of death related to SARS-CoV-2 infection over time and may have the ability to mitigate lung damage.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染对肺损伤的影响以及疫苗接种对控制死亡人数或减轻肺损伤的作用尚未得到系统研究。
对的里雅斯特省（2020 - 2022年）因新型冠状病毒肺炎（COVID-19）死亡的连续住院患者进行尸检分析。研究结果包括：（i）院内死亡率；（ii）COVID-19对死亡的影响；（iii）肺损伤的组织学程度；（iv）疫苗接种的影响。
对1038例因SARS-CoV-2感染死亡的连续住院患者进行了尸检，并对随机抽取的508例病例的肺部进行了深入的组织学分析。其中，SARS-CoV-2感染情况为：（a）死亡原因（n = 90）；（b）促成死亡（n = 304）；（c）伴随特征（n = 114）。SARS-CoV-2感染作为主要死亡原因的发生率随时间下降（2020年为23.8%，2021年为20.9%，2022年为7.9%）。多变量分析显示，在调整其他独立预测因素后，接种疫苗（任何剂量）与SARS-CoV-2感染相关的较低死亡率独立相关（风险比为0.15，p < 0.001）。共有172例患者在死亡时至少接种了两剂疫苗：93%为全程接种，7%为接种两剂。组织学分析显示，与未接种疫苗的患者相比，接种疫苗的患者肺炎严重程度评分为0和1的频率更高（分别为20.3%对5.4%和20.9%对7.7%，p < 0.001），肺炎严重程度评分为3的比例显著更低（26.2%对55.1%，p < 0.001）。
随着时间的推移，COVID-19疫苗接种大幅降低了SARS-CoV-2感染相关的死亡率，并且可能有减轻肺损伤的能力。
