Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 11;15(11):e0242300.
doi: 10.1371/journal.pone.0242300. eCollection 2020.

The clinical value of minimal invasive autopsy in COVID-19 patients

Valentino D'Onofrio  1   2 , Elena Donders  2 , Marie-Elena Vanden Abeele  3 , Jasperina Dubois  4 , Reinoud Cartuyvels  5 , Ruth Achten  6   7 , Martin Lammens  7   8 , Amelie Dendooven  7   8   9 , Ann Driessen  7   8 , Lukasz Augsburg  10 , Jan Vanrusselt  10 , Janneke Cox  1   2
Affiliations

The clinical value of minimal invasive autopsy in COVID-19 patients

Valentino D'Onofrio et al. PLoS One. .

Abstract

Background: Minimally invasive autopsy (MIA) is a validated and safe method to establish the cause of death (COD), mainly in low-resource settings. However, the additional clinical value of MIA in Coronavirus disease (COVID-19) patients in a high-resource setting is unknown. The objective was to assess if and how MIA changed clinical COD and contributing diagnoses in deceased COVID-19 patients.

Methods and findings: A prospective observational cohort from April to May 2020 in a 981-bed teaching hospital in the epicenter of the COVID-19 pandemic in Belgium was established. Patients who died with either PCR-confirmed or radiologically confirmed COVID-19 infection were consecutively included. MIA consisted of whole-body CT and CT-guided Tru-Cut® biopsies. Diagnostic modalities were clinical chart review, radiology, microbiology, and histopathology which were assessed by two independent experts per modality. MIA COD and contributing diagnoses were established during a multi-disciplinary meeting. Clinical COD (CCOD) and contributing diagnosis were abstracted from the discharge letter. The main outcomes were alterations in CCOD and contributing diagnoses after MIA, and the contribution of each diagnostic modality. We included 18 patients, of which 7 after intensive care unit hospitalization. MIA led to an alteration in 15/18 (83%) patients. The CCOD was altered in 5/18 (28%) patients. MIA found a new COD (1/5), a more specific COD (1/5), a less certain COD (1/5), or a contributing diagnosis to be the COD (2/5). Contributing diagnoses were altered in 14/18 (78%) patients: 9 new diagnoses, 5 diagnoses dismissed, 3 made more specific, and 2 made less certain. Overall, histopathology contributed in 14/15 (93%) patients with alterations, radiology and microbiology each in 6/15 (40%), and clinical review in 3/15 (20%). Histopathology was deemed the most important modality in 10 patients, radiology in two patients, and microbiology in one patient.

Conclusion: MIA, especially histological examination, can add valuable new clinical information regarding the cause of death in COVID-19 patients, even in a high-resource setting with wide access to premortem diagnostic modalities. MIA may provide important clinical insights and should be applied in the current ongoing pandemic.

Trial registration: Clinicaltrials.gov identifier: NCT04366882.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Castillo P, Martínez MJ, Ussene E, Jordao D, Lovane L, Ismail MR, et al. Validity of a Minimally Invasive Autopsy for Cause of Death Determination in Adults in Mozambique: An Observational Study. PLoS Med. 2016;13(11):e1002171 10.1371/journal.pmed.1002171 - DOI - PMC - PubMed
    1. Rakislova N IM, Martinez A, et al. Minimally Invasive Autopsy: a more feasible and safer alternative to conventional autopsy in the COVID-19 pandemic era?. Med Clin Sci. 2020, 2(3):1–5.
    1. Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Pathol. 2020;73(5):239–42. 10.1136/jclinpath-2020-206522 - DOI - PubMed
    1. Sciensano. Chronologie case definition document.
    1. Control ECfD. Case definition for coronavirus disease 2019 (COVID-19), as of 29 May 2020. 2020.

Publication types

MeSH terms

Associated data