Autopsy findings in COVID-19-related deaths: a literature review

Abstract

Although many clinical reports have been published, little is known about the pathological post-mortem findings from people who have died of the novel coronavirus disease. The need for postmortem information is urgent to improve patient management of mild and severe illness, and treatment strategies. The present systematic review was carried out according to the Preferred Reporting Items for Systematic Review (PRISMA) standards. A systematic literature search and a critical review of the collected studies were conducted. An electronic search of PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EMBASE) from database inception to June 2020 was performed. We found 28 scientific papers; the total amount of cases is 341. The major histological feature in the lung is diffuse alveolar damage with hyaline membrane formation, alongside microthrombi in small pulmonary vessels. It appears that there is a high incidence of deep vein thrombosis and pulmonary embolism among COVID-19 decedents, suggesting endothelial involvement, but more studies are needed. A uniform COVID-19 post-mortem diagnostic protocol has not yet been developed. In a time in which international collaboration is essential, standardized diagnostic criteria are fundamental requirements.

Keywords: Autopsy; COVID-19; Findings; Pathophysiology.

Fig. 1

An appraisal based on titles and abstracts as well as a hand search of reference lists was carried out. The resulting 125 references were screened to exclude duplicates, which left 48 articles for further consideration. In addition, non-English papers were excluded and the following inclusion criteria were used: (1) original research articles, (2) reviews and mini-reviews, and (3) case report/series. These publications were carefully evaluated taking into account the main aims of the review. This evaluation left 28 scientific papers (8 concerning minimally invasive autopsies, 20 concerning complete autopsies), distributed as original research articles, case report/series, reviews, and mini-reviews

Fig. 2

Typical histological findings described in the literature: a–b lung tissue showed edema, early stage DAD with hyaline membranes (arrows) and intraalveolar hemorrhages (H&E, × 40, × 100). c Lung: microvascular thrombi (arrows) (H&E, × 60), capillary congestion, and edema. DAD: d exudative phases (arrows) (Anti-Surfactant Protein A Antibody, × 40) with microvascular thrombi (arrows) e (Weigert, × 20)