Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course

Jose-Manuel Ramos-Rincon; Cristian Herrera-García; Sandra Silva-Ortega; Julia Portilla-Tamarit; Cristina Alenda; Francisco-Angel Jaime-Sanchez; Juan Arenas-Jiménez; Francisca-Eugenia Fornés-Riera; Alexander Scholz; Isabel Escribano; Víctor Pedrero-Castillo; Carlos Muñoz-Miguelsanz; Pedro Orts-Llinares; Ana Martí-Pastor; Antonio Amo-Lozano; Raquel García-Sevila; Isabel Ribes-Mengual; Oscar Moreno-Perez; Luis Concepcion-Aramendía; Esperanza Merino; Rosario Sánchez-Martínez; Ignacio Aranda

doi:10.3389/fmed.2022.874307

Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course

Front Med (Lausanne). 2022 Jul 7:9:874307. doi: 10.3389/fmed.2022.874307. eCollection 2022.

Authors

Jose-Manuel Ramos-Rincon^{1

2}, Cristian Herrera-García¹, Sandra Silva-Ortega³, Julia Portilla-Tamarit¹, Cristina Alenda^{3

4}, Francisco-Angel Jaime-Sanchez^{2

5}, Juan Arenas-Jiménez^{4

6}, Francisca-Eugenia Fornés-Riera⁷, Alexander Scholz¹, Isabel Escribano⁸, Víctor Pedrero-Castillo³, Carlos Muñoz-Miguelsanz⁷, Pedro Orts-Llinares⁵, Ana Martí-Pastor¹, Antonio Amo-Lozano¹, Raquel García-Sevila⁹, Isabel Ribes-Mengual¹, Oscar Moreno-Perez^{2

10}, Luis Concepcion-Aramendía⁶, Esperanza Merino¹¹, Rosario Sánchez-Martínez^{1

2}, Ignacio Aranda³

Affiliations

¹ Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.
² Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain.
³ Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.
⁴ Pathology and Surgery Department, Miguel Hernández University of Elche, Elche, Spain.
⁵ Intensive Care Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.
⁶ Radiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.
⁷ Anesthesiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.
⁸ Microbiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.
⁹ Pneumology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.
¹⁰ Endocrinology and Nutrition Department, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.
¹¹ Infectious Diseases Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.

Abstract

Background: Autopsies can shed light on the pathogenesis of new and emerging diseases.

Aim: To describe needle core necropsy findings of the lung, heart, and liver in decedents with COVID-19.

Material: Cross-sectional study of needle core necropsies in patients who died with virologically confirmed COVID-19. Histopathological analyses were performed, and clinical data and patient course evaluated.

Results: Chest core necropsies were performed in 71 decedents with a median age of 81 years (range 52-97); 47 (65.3%) were men. The median interval from symptoms onset to death was 17.5 days (range 1-84). Samples of lung (n = 62, 87.3%), heart (n = 48, 67.6%) and liver (n = 39, 54.9%) were obtained. Fifty-one lung samples (82.3%) were abnormal: 19 (30.6%) showed proliferative diffuse alveolar damage (DAD), 12 (19.4%) presented exudative DAD, and 10 (16.1%) exhibited proliferative plus exudative DAD. Of the 46 lung samples tested for SARS-CoV-19 by RT-PCR, 39 (84.8%) were positive. DAD was associated with premortem values of lactate dehydrogenase of 400 U/L or higher [adjusted odds ratio (AOR) 21.73; 95% confidence interval (CI) 3.22-146] and treatment with tocilizumab (AOR 6.91; 95% CI 1.14-41.7). Proliferative DAD was associated with an onset-to-death interval of over 15 days (AOR 7.85, 95% CI 1.29-47.80). Twenty-three of the 48 (47.9%) heart samples were abnormal: all showed fiber hypertrophy, while 9 (18.8%) presented fibrosis. Of the liver samples, 29/39 (74.4%) were abnormal, due to steatosis (n = 12, 30.8%), cholestasis (n = 6, 15.4%) and lobular central necrosis (n = 5, 12.8%).

Conclusion: Proliferative DAD was the main finding on lung core needle necropsy in people who died from COVID-19; this finding was related to a longer disease course. Changes in the liver and heart were common.

Keywords: COVID-19; SARS-CoV-2; autopsy; coronavirus; pathology.

Copyright © 2022 Ramos-Rincon, Herrera-García, Silva-Ortega, Portilla-Tamarit, Alenda, Jaime-Sanchez, Arenas-Jiménez, Fornés-Riera, Scholz, Escribano, Pedrero-Castillo, Muñoz-Miguelsanz, Orts-Llinares, Martí-Pastor, Amo-Lozano, García-Sevila, Ribes-Mengual, Moreno-Perez, Concepcion-Aramendía, Merino, Sánchez-Martínez and Aranda.