Dumache Raluca, Muresan Camelia Oana, Laitin Sorina Maria Denisa, Ivanovic Nina, Chisalita Adina, Herlo Alexandra, Marinescu Adelina, Lazureanu Elena Voichita, Cut Talida Georgiana
Department of Forensic Medicine, Bioethics, Medical Ethics and Medical Law, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Center for Ethics in Human Genetic Identifications, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Diagnostics (Basel). 2025 Jul 24;15(15):1860. doi: 10.3390/diagnostics15151860.
Coronavirus Disease 2019 (COVID-19) may cause extensive multi-organ pathology, particularly in the lungs, heart, kidneys, and liver. While hypercoagulability-often signaled by elevated D-dimer-has been thoroughly investigated, the concurrent pathological findings across organs and their interrelation with distinct D-dimer levels remain incompletely characterized. This study aimed to evaluate the pathological changes observed in autopsied or deceased COVID-19 patients, focusing on the prevalence of organ-specific lesions, and to perform subgroup analyses based on three D-dimer categories. We conducted a retrospective review of 69 COVID-19 patients from a Romanian-language dataset, translating all clinical and pathological descriptions into English. Pathological findings (pulmonary microthrombi, bronchopneumonia, myocardial fibrosis, hepatic steatosis, and renal tubular necrosis) were cataloged. Patients were grouped into three categories by admission D-dimer: <500 ng/mL, 500-2000 ng/mL, and ≥2000 ng/mL. Laboratory parameters (C-reactive protein, fibrinogen, and erythrocyte sedimentation rate) and clinical outcomes (intensive care unit [ICU] admission, mechanical ventilation, and mortality) were also recorded. Intergroup comparisons were performed with chi-square tests for categorical data and one-way ANOVA or the Kruskal-Wallis test for continuous data. Marked organ pathology was significantly more frequent in the highest D-dimer group (≥2000 ng/mL). Pulmonary microthrombi and bronchopneumonia increased stepwise across ascending D-dimer strata ( < 0.05). Myocardial and renal lesions similarly showed higher prevalence in patients with elevated D-dimer. Correlation analysis revealed that severe lung and heart pathologies were strongly associated with high inflammatory markers and a greater risk of ICU admission and mortality. Our findings underscore that COVID-19-related organ damage is magnified in patients with significantly elevated D-dimer. By integrating pathology reports with clinical and laboratory data, we highlight the prognostic role of hypercoagulability and systemic inflammation in the pathogenesis of multi-organ complications. Stratifying patients by D-dimer may inform more tailored management strategies, particularly in those at highest risk of severe pathology and adverse clinical outcomes.
2019冠状病毒病（COVID-19）可能导致广泛的多器官病变，尤其是在肺部、心脏、肾脏和肝脏。虽然高凝状态（通常以D-二聚体升高为信号）已得到充分研究，但各器官同时出现的病理表现及其与不同D-二聚体水平的相互关系仍未完全明确。本研究旨在评估在接受尸检或已死亡的COVID-19患者中观察到的病理变化，重点关注器官特异性病变的发生率，并基于三种D-二聚体类别进行亚组分析。我们对来自罗马尼亚语数据集的69例COVID-19患者进行了回顾性研究，将所有临床和病理描述翻译成英文。对病理结果（肺微血栓、支气管肺炎、心肌纤维化、肝脂肪变性和肾小管坏死）进行了分类记录。根据入院时的D-二聚体水平将患者分为三类：<500 ng/mL、500 - 2000 ng/mL和≥2000 ng/mL。还记录了实验室参数（C反应蛋白、纤维蛋白原和红细胞沉降率）和临床结局（重症监护病房[ICU]入院、机械通气和死亡率）。分类数据采用卡方检验进行组间比较，连续数据采用单因素方差分析或Kruskal-Wallis检验进行组间比较。在最高D-二聚体组（≥2000 ng/mL）中，明显的器官病理改变更为常见。肺微血栓和支气管肺炎在D-二聚体水平升高的各分层中呈逐步增加趋势（<0.05）。心肌和肾脏病变在D-二聚体升高的患者中同样具有较高的发生率。相关性分析显示，严重的肺部和心脏病变与高炎症标志物以及更高的ICU入院和死亡风险密切相关。我们的研究结果强调，D-二聚体显著升高的COVID-19患者中与疾病相关的器官损伤会加剧。通过将病理报告与临床和实验室数据相结合，我们突出了高凝状态和全身炎症在多器官并发症发病机制中的预后作用。根据D-二聚体对患者进行分层可能有助于制定更具针对性的管理策略，特别是对于那些具有严重病理和不良临床结局最高风险的患者。
