What can autopsy say about COVID-19? A case series of 60 autopsies

Simone Grassi; Vincenzo Arena; Massimo Zedda; Francesca Cazzato; Rossella Cianci; Giovanni Gambassi; Antonio Oliva

doi:10.1016/j.legalmed.2023.102241

What can autopsy say about COVID-19? A case series of 60 autopsies

Leg Med (Tokyo). 2023 May:62:102241. doi: 10.1016/j.legalmed.2023.102241. Epub 2023 Mar 12.

Authors

Simone Grassi¹, Vincenzo Arena², Massimo Zedda³, Francesca Cazzato⁴, Rossella Cianci⁵, Giovanni Gambassi⁵, Antonio Oliva⁴

Affiliations

¹ 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.
² Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00147, Italy.
³ Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Electronic address: massimo.zedda01@icatt.it.
⁴ Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
⁵ Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome 00168, Italy.

Abstract

Introduction: 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.

Materials and methods: 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.

Results: 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).

Conclusions: 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.

Keywords: COVID-19; Forensic pathology; SARS-CoV-2.

MeSH terms

Acute Kidney Injury*
Autopsy
COVID-19*
Cadaver
Death
Humans
SARS-CoV-2