Clinical, Virological, and Pathological Profile of Patients Who Died of COVID-19: An Autopsy-Based Study From India

Abstract

Background and objective Ever since its emergence in December 2019, coronavirus disease 2019 (COVID-19) has affected more than 220 million people worldwide, resulting in more than 45 million deaths. The present autopsy-based study was undertaken to understand the pathophysiology of the disease and correlate the histopathological and virological findings with the antemortem clinical and biochemical determinants. Methods In this prospective observational study, autopsies were carried out on 21 reverse transcription-polymerase chain reaction (RT-PCR)-proven COVID-19 patients who had died of the disease. The histopathological findings of tissue samples from lungs, liver, and kidneys collected during the autopsy were graded based on their presence or absence; if present, they were graded as either focal or diffuse. The findings were correlated with antemortem clinical and biochemical findings. Postmortem tissue RT-PCR analysis was conducted, and findings were compared with postmortem histopathological findings. Results There was multisystem involvement with the COVID-19 cases. The involvement of lungs was observed in most of the cases (90.4%). The presence of viral RNA was observed in all the organs including the liver (57.1%) and kidney (66.6%). An association was observed between antemortem biochemical parameters [aspartate aminotransferase (AST), alanine aminotransferase (ALT)] and the histopathological features in the liver. No correlation between the Sequential Organ Failure Assessment (SOFA) score recorded clinically and lung histopathology was observed; nor was there any correlation between blood urea-creatinine levels and kidney histopathology. Conclusions Our study shows that COVID-19 is a multisystemic disease and the mortality associated with it is likely to be multifactorial. Despite the presence of amplifiable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various organs, no association could be established between the clinical and histopathology findings. Neither the duration of hospitalization nor the duration of mechanical ventilation showed any correlation with the severity of histopathological findings in the lungs at autopsy.

Keywords: covid 19 autopsy; covid 19 clinioicopathologic features; covid 19 india; covid autopsy of liver and kidney; covid autopsy of lung; histopathology of lungs in covid 19; virology of tissues in covid 19.

Figure 1. Haematoxylin and eosin-stained sections of lung parenchyma displaying various histopathological features

(A) Blood vessel showing fibrin thrombi (100x). (B) Presence of hyaline membranes in exudative phase (100x). (C) Pneumocyte hyperplasia with viral cytopathic effects in proliferative phase (400x). (D) Multinucleated giant cells (400x). (E) Squamous metaplasia (100x). (F) Fibrosis of the lung parenchyma in fibrotic phase (40x)

Figure 2. Distribution of clinical severity (SOFA score) with histopathological findings in lungs

SOFA: Sequential Organ Failure Assessment

Figure 3. Haematoxylin and eosin-stained section of liver parenchyma displaying macrovesicular change (100x)

Figure 4. Distribution of AST and ALT values with the histopathological findings in the liver

AST: aspartate aminotransferase; ALT: alanine aminotransferase

Figure 5. Histopathological findings of renal parenchyma

(A) Gross appearance of bilateral kidney in a single case showing congestion of the external surface. (B) Acute tubular necrosis (100x). (C) Acute tubular necrosis with sclerosed glomeruli (40x). (D) Sclerosed glomerulus in diabetic nephropathy (100x)

Figure 6. Distribution of urea and creatinine with the histopathological findings in the liver

Figure 7. Extent of the involvement of organs

(A) Extent of the involvement of lungs. (B) Extent of the involvement of the liver. (C) Extent of the involvement of kidneys