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
. 2022 Dec 28:15:8743-8753.
doi: 10.2147/IJGM.S389300. eCollection 2022.

Autopsy Findings and Inflammatory Markers in SARS-CoV-2: A Single-Center Experience

Talida Georgiana Cut  1   2   3   4   5 , Veronica Ciocan  4   6 , Dorin Novacescu  3   5 , Adrian Voicu  7 , Adelina Raluca Marinescu  1   2 , Voichita Elena Lazureanu  1   2 , Camelia Oana Muresan  4   6 , Alexandra Enache  4   6 , Raluca Dumache  4   6
Affiliations

Autopsy Findings and Inflammatory Markers in SARS-CoV-2: A Single-Center Experience

Talida Georgiana Cut et al. Int J Gen Med. .

Abstract

Purpose: The systemic inflammatory response related to COVID-19 can be easily investigated in living patients. Unfortunately, not every biomarker is suitable for postmortem analysis since several factors may interfere. The aim of this study was to summarize key histopathological findings within each organ system due to COVID-19 and to assess if serological inexpensive and widely available biomarkers such as CRP, IL-6, fibrinogen and d-Dimers, associated with adverse outcomes in COVID-19, can be implemented in a post-mortem assessment.

Patients and methods: A total of 60 subjects divided in 2 groups were included. All subjects died outside a hospital setting and therefore did not receive specific or symptomatic therapies that could have modulated the inflammatory response. The first group included 45 subjects in which mandatory autopsy was performed in order to establish the cause of death and macroscopic examination of the lungs was highly suggestive of SARS-CoV-2 infection. As controls (Group 2), 20 subjects who died from polytrauma in high velocity car accidents and suicide were selected. Bronchial fluids collected during the autopsy procedure were used for the RT-PCR diagnosis of SARS-CoV-2 and serum samples were sent for analysis of IL-6, CRP, d-Dimers and fibrinogen.

Results: Compared with the control group, the subjects of the COVID-19 group were older (59±19.5 vs.38±19.15 years, p=0.0002) and had more underlying comorbidities such as hypertension (60% vs 35%, p=0.06) or were overweight (53.3% vs 30%, p=0.08). The levels of CRP, IL-6, fibrinogen and d-Dimers in postmortem plasma samples were significantly higher in COVID-19 subjects than in control group (p< 0.0001). Moreover, the level of IL-6 was significantly higher in overweight patients (r=0.52, P<0.001). In all COVID-19 subjects, the histological examination revealed features corresponding to the exudative and/or proliferative phases of diffuse alveolar damage. Large pulmonary emboli were observed in 7 cases. Gross cardiac enlargement with left ventricular hypertrophy was observed in 19 cases. The most frequent pathological finding of the central nervous system was acute/early-subacute infarction.

Conclusion: Due to the complexity of the inflammatory response, we postulate that a combination of biomarkers, rather than a single laboratory parameter, might be more effective in obtaining a reliable postmortem COVID-19 diagnosis.

Keywords: C reactive protein; COVID-19; diffuse alveolar damage; interleukin-6; postmortem.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Statistically significant difference in the group of COVID-19 positive cases compared to the control group for the laboratory findings.
Figure 2
Figure 2
The Spearman rank correlation between IL-6 and other inflammatory parameters.
Figure 3
Figure 3
The Spearman rank correlation between IL-6 and comorbidities.
Figure 4
Figure 4
Lung tissue with edema, DAD with hyaline membranes and microvascular thrombi (H&E,x40).
Figure 5
Figure 5
Macroscopic examination of heart – multiple white nodular areas highly suggestive of microinfarcts; postmortem clots intermingled with chordae tendineae.
Figure 6
Figure 6
Inflammatory infiltration, necrosis and microvascular thrombi in myocardium (H&E,x40).
See this image and copyright information in PMC

References

    1. Enache A, Ciocan V, Muresan CO, et al. Postmortem documentation of SARS-CoV-2 in utero and postpartum transmission, through amniotic fluid, placental, and pulmonary tissue RT-PCR. Appl Sci. 2021;11(20):9505. doi:10.3390/app11209505 - DOI
    1. Carsana L, Sonzogni A, Nasr A, et al. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect Dis. 2020;20(10):1135–1140. doi:10.1016/S1473-3099(20)30434-5 - DOI - PMC - PubMed
    1. Cut TG, Tudoran C, Lazureanu VE, Marinescu AR, Dumache R, Tudoran M. Spontaneous pneumomediastinum, pneumothorax, pneumopericardium and subcutaneous emphysema—not so uncommon complications in patients with COVID-19 pulmonary infection—a series of cases. JCM. 2021;10(7):1346. doi:10.3390/jcm10071346 - DOI - PMC - PubMed
    1. Calabrese F, Pezzuto F, Fortarezza F, et al. Pulmonary pathology and COVID-19: lessons from autopsy. the experience of European pulmonary pathologists. Virchows Arch. 2020;477(3):359–372. doi:10.1007/s00428-020-02886-6 - DOI - PMC - PubMed
    1. Lupariello F, Godio L, Di Vella G. Immunohistochemistry patterns of SARS-CoV-2 deaths in forensic autopsies. Leg Med. 2021;51:101894. doi:10.1016/j.legalmed.2021.101894 - DOI - PMC - PubMed