Minimally invasive autopsies for the investigation of pulmonary pathology of COVID-19-experiences of a longitudinal series of 92 patients

Petar Noack; Claudia Grosse; Jacob Bodingbauer; Marion Almeder; Sylvia Lohfink-Schumm; Helmut J F Salzer; Jens Meier; Bernd Lamprecht; Clemens A Schmitt; Rupert Langer

doi:10.1007/s00428-023-03622-6

Minimally invasive autopsies for the investigation of pulmonary pathology of COVID-19-experiences of a longitudinal series of 92 patients

Virchows Arch. 2023 Nov;483(5):611-619. doi: 10.1007/s00428-023-03622-6. Epub 2023 Sep 1.

Authors

Petar Noack^#^{1

2}, Claudia Grosse^#¹, Jacob Bodingbauer^{1

2}, Marion Almeder^{1

2}, Sylvia Lohfink-Schumm^{1

2}, Helmut J F Salzer^{2

3

4}, Jens Meier^{2

5}, Bernd Lamprecht^{2

6}, Clemens A Schmitt^{2

7}, Rupert Langer^{8

9}

Affiliations

¹ Institute of Clinical Pathology, Kepler University Hospital, Krankenhausstr. 9, 4021, Linz, Austria.
² Medical Faculty, Johannes Kepler University, Linz, Austria.
³ Division of Infectious Diseases and Tropical Medicine, Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria.
⁴ Ignaz-Semmelweis-Institute, Interuniversity Institute for Infection Research, Vienna, Austria.
⁵ Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital, Linz, Austria.
⁶ Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria.
⁷ Department of Hematology and Medical Oncology, Kepler University Hospital, Linz, Austria.
⁸ Institute of Clinical Pathology, Kepler University Hospital, Krankenhausstr. 9, 4021, Linz, Austria. rupert.langer@kepleruniklinikum.at.
⁹ Medical Faculty, Johannes Kepler University, Linz, Austria. rupert.langer@kepleruniklinikum.at.

^# Contributed equally.

Abstract

Minimally invasive autopsies (MIAs) allow the collection of tissue samples for diagnostic and research purposes in special situations, e.g., when there is a high risk of infection which is the case in the context of COVID-19 or restrictions due to legal or personal reasons. We performed MIA to analyze lung tissue from 92 COVID-19 patients (mean age 78 years; range 48-98; 35 women, 57 men), representing 44% of all patients who died from the disease between October 2020 and April 2021. An intercostal approach was used with removal of a 5-cm rib section followed by manual collection of four lung tissue samples (5-8 cm in size). Diffuse alveolar damage (DAD) was found in 89 (97%) patients at various stages. Exudative DAD (eDAD) predominated in 18 (20%) patients, proliferative DAD (pDAD) in 43 (47%) patients, and mixed DAD (mDAD) in 31 (34%) patients. There were no significant differences in the predominant DAD pattern between tissue samples from the same patient. Additional purulent components were present in 46 (50%) cases. Fungi were detected in 11 (12%) patients. The pDAD pattern was associated with longer hospital stay including intensive care unit (p=0.026 and p<0.001) and younger age (p=0.019). Positive bronchoalveolar lavage and blood cultures were observed more frequently in pDAD patterns (p<0.001; p=0.018). In contrast, there was no significant association between intravital positive microbiological results and superimposed bronchopneumonia or fungal infection at autopsy. Having demonstrated the characteristic lung changes in a large longitudinal autopsy series, we conclude that the presented MIA approach can be considered a reliable and safe method for performing post mortem lung diagnostics in COVID-19 and other high-risk situations. The lack of correlation between histological changes indicative of bacterial or fungal superinfection and microbiology could have clinical implications for disease and treatment surveillance.

Keywords: COVID-19; Diffuse alveolar damage; Minimally invasive autopsy; Pulmonary pathology.

MeSH terms

Aged
Autopsy / methods
COVID-19* / pathology
Female
Humans
Lung / pathology
Male