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. 2023 Jul 4:10:1151843.
doi: 10.3389/fmed.2023.1151843. eCollection 2023.

Post-mortem findings in Spanish patients with COVID-19; a special focus on superinfections

Inmaculada Ruiz-Cáceres  1   2 , Teresa Hermida Romero  3 , Isabel Guerra Merino  4 , Joseba Portu Zapirain  5   6 , Belén Pérez-Mies  7 , Matilde Sánchez-Conde  8 , Marina Alonso Riaño  9 , Rafael Rubio  10 , Jose Fortés Alen  11 , Ánxela Vidal González  12 , Clara Salas Antón  13 , Elena Múñez  14 , Rafael Sánchez Sánchez  15 , Diana Corona-Mata  1 , Iban Aldecoa Ansorregui  16 , José M Miró  17   18 , Raquel Beloqui Pérez de Obanos  19 , Carlos Ibero  20 , Javier Gómez-Román  21 , M Carmen Fariñas  22 , Teresa Tabuyo Bello  23 , Enrique de Alava  24 , José Miguel Cisneros  25 , Xavier Matías-Guiu  26 , Antonio Rivero  1 ; NECROCOVID Study Group
Affiliations

Post-mortem findings in Spanish patients with COVID-19; a special focus on superinfections

Inmaculada Ruiz-Cáceres et al. Front Med (Lausanne). .

Abstract

Introduction: Whole-body autopsies may be crucial to understand coronavirus disease 2019 (COVID-19) pathophysiology. We aimed to analyze pathological findings in a large series of full-body autopsies, with a special focus on superinfections.

Methods: This was a prospective multicenter study that included 70 COVID-19 autopsies performed between April 2020 and February 2021. Epidemiological, clinical and pathological information was collected using a standardized case report form.

Results: Median (IQR) age was 70 (range 63.75-74.25) years and 76% of cases were males. Most patients (90%,) had at least one comorbidity prior to COVID-19 diagnosis, with vascular risk factors being the most frequent. Infectious complications were developed by 65.71% of the patients during their follow-up. Mechanical ventilation was required in most patients (75.71%) and was mainly invasive. In multivariate analyses, length of hospital stay and invasive mechanical ventilation were significantly associated with infections (p = 0.036 and p = 0.013, respectively). Necropsy findings revealed diffuse alveolar damage in the lungs, left ventricular hypertrophy in the heart, liver steatosis and pre-infection arteriosclerosis in the heart and kidneys.

Conclusion: Our study confirms the main necropsy histopathological findings attributed to COVID-19 in a large patient series, while underlining the importance of both comorbid conditions and superinfections in the pathology.

Keywords: COVID-19; autopsies; infection; pathological findings; superinfection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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