{"id":5863,"date":"2022-12-01T06:00:00","date_gmt":"2022-12-01T06:00:00","guid":{"rendered":"http:\/\/wp.cov19longhaulfoundation.org\/?p=5863"},"modified":"2022-12-01T06:00:00","modified_gmt":"2022-12-01T06:00:00","slug":"autopsy-based-pulmonary-and-vascular-pathology-pulmonary-endotheliitis-and-multi-organ-involvement-in-covid-19-associated-deaths","status":"publish","type":"post","link":"https:\/\/cov19longhaulfoundation.org\/?p=5863","title":{"rendered":"Autopsy-Based Pulmonary and Vascular Pathology: Pulmonary Endotheliitis and Multi-Organ Involvement in COVID-19 Associated Deaths"},"content":{"rendered":"\n

Authors: artina Haberecker<\/a> University Hospital Z\u00fcrich<\/a> Esther I Schwarz<\/a> University of Zurich<\/a> <\/a>Peter Steiger<\/a> University of Zurich<\/a> <\/a>Karl Frontzek<\/a> University of Zurich<\/a>September 2021 Respiration<\/a> 101(2):1-11 DOI:10.1159\/000518914<\/a>License CC BY-NC 4.0<\/a><\/p>\n\n\n\n

Abstract and Figures<\/h2>\n\n\n\n

Background: Findings from autopsies have provided evidence on systemic microvascular damage as one of the underlying mechanisms of Coronavirus disease 2019 (CO-VID-19). The aim of this study was to correlate autopsy-based cause of death in SARS-CoV-2, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients with chest imaging and severity grade of pulmonary and systemic morphological vascular pathology. Methods: Fifteen SARS-CoV-2 positive autopsies with clinically distinct presentations (age 22-89 years) were retrospectively analyzed with focus on vascular, thromboembolic, and ischemic changes in pulmonary and in extrapulmonary sites. Eight patients died due to COVID-19 associated respiratory failure with diffuse alveolar damage in various stages and\/or multi-organ failure, whereas other reasons such as cardiac decompensation, complication of malignant tumors, or septic shock were the cause of death in 7 further patients. The severity of gross and histopathological changes was semi-quantitatively scored as 0 (absent), 1 (mild), and 3 (severe). Severity scores between the 2 groups were correlated with selected clinical parameters, initial chest imaging, autopsy-based cause of death, and compared using Pearson \u03c72 and Mann-Whitney U tests. Results: Severe pulmonary endotheliitis (p = 0.031, p = 0.029) and multi-organ involvement (p = 0.026, p = 0.006) correlated significantly with COVID-19 associated death. Pulmonary microthrombi showed limited statistical correlation, while tissue necrosis, gross pulmonary embolism, and bacterial superinfection did not differentiate the 2 study groups. Chest imaging at hospital admission did not differ either. Conclusions: Extensive pulmonary endotheliitis and multi-organ involvement are characteristic autopsy features in fatal CO-VID-19 associated deaths. Thromboembolic and ischemic events and bacterial superinfections occur frequently in SARS-CoV-2 infection independently of outcome.<\/a><\/p>\n\n\n\n

\"Histological<\/a><\/figure>\n\n\n\n

Histological vascular and gross pulmonary vascular findings in SARS-CoV-2 positive autopsies. Images demonstrate severe grade of vascular changes (larger involved areas and high number of foci) (a-d), images show mild grade morphological changes (smaller or only scattered areas involved) (e-h). Numerous (a) and only scattered (e) lymphocytes beneath the endothelium. Multiple middle-and small-sized (b and c) and only scattered small-sized peripheral (f, g) fibrin and leucocytic thrombi. Large multiple areas (d) and only small foci (h) of pulmonary hemorrhagic infarction and consolidation. a-g: H & E stain. b (inset): modified Picro-Mallory stain. H&E, hematoxylin and eosin; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2<\/a><\/a><\/p>\n\n\n\n

Figures – available via license: Creative Commons Attribution-NonCommercial 4.0 International<\/a><\/p>\n\n\n\n

Content may be subject to copyright.<\/p>\n","protected":false},"excerpt":{"rendered":"

Authors: artina Haberecker University Hospital Z\u00fcrich Esther I Schwarz University of Zurich Peter Steiger University of Zurich Karl Frontzek University of ZurichSeptember 2021 Respiration 101(2):1-11 DOI:10.1159\/000518914License CC BY-NC 4.0 Abstract and […]<\/p>\n","protected":false},"author":2,"featured_media":5889,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[90,144,333,403],"tags":[],"class_list":["post-5863","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clots-bleeds","category-endothelium","category-mortality-morbidity","category-organ-failure"],"_links":{"self":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/5863","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5863"}],"version-history":[{"count":0,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/5863\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/media\/5889"}],"wp:attachment":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5863"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5863"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5863"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}