The objective of this prospective cohort study was to validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virological tests of 12 patients who died with a polymerase chain reaction– confirmed diagnosis of COVID-19. Each case was evaluated through a complete autopsy, including post-mortem computed tomography and histopathologic and virological analysis.
The median patient age was 73 years (range, 52 to 87 years) and 75% of patients were male. Coronary heart disease and asthma/chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7/12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Post-mortem computed tomography revealed reticular infiltration of the lungs with severe bilateral, dense consolidation, whereas histomorphologically diffuse alveolar damage was seen in 8 patients. In all patients, SARS–CoV-2 RNA was detected in the lungs in high concentrations; viraemia was evident in 6/10, and 5/12 patients demonstrated high viral RNA titers in the liver, kidney, or heart. The authors concluded that the high incidence of thromboembolic events suggests an important role of COVID-19–induced coagulopathy.
by Marialuisa Zedde and Francesco Cavallieri