COVID-19 pathology: experience of 2000 autopsies

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  • 作者: Zayratyants O.1,2,3, Samsonova M.4, Cherniaev A.3,4, Mishnev O.5, Mikhaleva L.3,6, Krupnov N.7, Kalinin D.8
  • 隶属关系:
    1. «A.I. Evdokimov Moscow State University of Medicine and Dentistry» Ministry of Health of Russian Federation
    2. The State Budgetary Healthcare Institution of Moscow Area Moscows regional research clinical institute n.a. M.F. Vladimirskiy
    3. Research Institute of Human Morphology
    4. Federal State Budgetary Institution «Pulmonology Scientific Research Institute under Federal Medical and Biological Agency of Russsian Federation»
    5. ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России
    6. City Clinical Hospital No. 31
    7. State Budgetary Institution «D.I. Mastbaum Forensic Medical Bureau»
    8. Federal State Budget Scientific Research Center «A.V. Vishnevsky Institute of Surgery» of the Ministry of Health of Russian Federation
  • 期: 卷 6, 编号 4 (2020)
  • 页面: 10-23
  • 栏目: ORIGINAL STUDY ARTICLES
  • URL: https://journals.rcsi.science/2411-8729/article/view/122396
  • DOI: https://doi.org/10.19048/fm340
  • ID: 122396

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Background: Pathological anatomy, patogenesis and the morphogenesis of manifestations and complications of COVID-19 remain insufficiently studied. The fullest information on structural bases of organs and tissues alterations by new coronavirus disease can be obtained as a result of autopsies.

Aims: The aim of the study was to study the morphological changes of lungs and other organs of the autopsies of COVID-19 deceased persons. Results of 2000 autopsies of people who died of a severe form of COVID-19 in Moscow, consisting of 1212 men and 788 women, from March 20 to May 22, 2020 (a ratio 1.54:1) aged from 20 to 99 years (on average 68.5±15.63 years) were presented. This experience was previously generalized in the Atlas COVID-19 pathology. Autopsies were made in the converted interstationary pathoanatomical offices at strict observance of rules of biosafety according to standard and legal documents of WHO, Russian Ministry of Health and Rospotrebnadzor.

Results: Morphological changes of lungs with varying severity and extent were detected in all examined cases; however, damage to other organs was also common, which in some cases prevailed over pulmonary changes and was the cause of death. The main morphological changes in lungs were diffuse alveolar damage and microangiopathy, alveolar hemorrhage syndrome, thrombosis, and thromboembolism.

Conclusion: The involvement of the lungs, other organs, and vascular system in the pathological process is a result of multiple factors. It is advisable to implement clinical and morphological «masks» of COVID-19.

作者简介

Oleg Zayratyants

«A.I. Evdokimov Moscow State University of Medicine and Dentistry» Ministry of Health of Russian Federation; The State Budgetary Healthcare Institution of Moscow Area Moscows regional research clinical institute n.a. M.F. Vladimirskiy; Research Institute of Human Morphology

编辑信件的主要联系方式.
Email: ovzair@mail.ru
ORCID iD: 0000-0003-3606-3823

Dr. Sci. Med., professor

俄罗斯联邦, 20/1 Delegatskaya street, 127473, Moscow; Moscow; Moscow

Maria Samsonova

Federal State Budgetary Institution «Pulmonology Scientific Research Institute under Federal Medical and Biological Agency of Russsian Federation»

Email: samary@mail.ru
ORCID iD: 0000-0001-8170-1260
SPIN 代码: 9525-9085

Dr. Sci. Med.

俄罗斯联邦, Moscow

Andrey Cherniaev

Research Institute of Human Morphology; Federal State Budgetary Institution «Pulmonology Scientific Research Institute under Federal Medical and Biological Agency of Russsian Federation»

Email: cheral12@gmail.com
ORCID iD: 0000-0003-0973-9250

Dr. Sci. Med., Professor

俄罗斯联邦, Moscow; Moscow

Oleko Mishnev

ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России

Email: mishnevod@gmail.com
ORCID iD: 0000-0002-6466-9147

Dr. Sci. Med., Professor

俄罗斯联邦, Москва

Liudmila Mikhaleva

Research Institute of Human Morphology; City Clinical Hospital No. 31

Email: mikhalevalm@yandex.ru
ORCID iD: 0000-0003-2052-914X
SPIN 代码: 2086-7513

Dr. Sci. Med., Professor

俄罗斯联邦, Moscow; Moscow

Nikolai Krupnov

State Budgetary Institution «D.I. Mastbaum Forensic Medical Bureau»

Email: Krupatan@yandex.ru
ORCID iD: 0000-0002-5162-1662
SPIN 代码: 4814-3226

Cand. Sci. (Med.)

俄罗斯联邦, Ryazan

Dmitry Kalinin

Federal State Budget Scientific Research Center «A.V. Vishnevsky Institute of Surgery» of the Ministry of Health of Russian Federation

Email: dmitry.v.kalinin@gmail.com
ORCID iD: 0000-0001-6247-9481

Cand. Sci. (Med.)

俄罗斯联邦, Moscow

参考

  1. Temporary guidelines: prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 7 (03.06.2020). Moscow; 2020. 166 р. (In Russ). Available from: https://static-0.rosminzdrav.ru/system/attachments/attaches/000/050/584/original/03062020_%D0%9CR_COVID-19_v7.pdf
  2. International guidelines for certification and classification (coding) of COVID-19 as cause of death. Based on ICD International Statistical Classification of Diseases (20 April 2020). WHO/HQ/DDI/DNA/CAT; 2020. Available from: https://www.who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-19-20200420-EN.pdf?ua=1
  3. Rules of work of pathoanatomical departments in case of coronavirus infection (COVID-19). Pathological anatomy of COVID-19. The provisional guidelines. Version 2 (27.04.2020). Moscow: 2020. 44 р. (In Russ). Available from: http://www.patolog.ru/sites/default/files/metodichka_dz_.pdf
  4. Nikiforov VV, Suranova TG, Mironov AYu, Zabozlaev FG. New coronavirus infection (COVID-19): etiology, epidemiology, clinic, diagnosis, treatment and prevention. Educational and methodological guide. Moscow; 2020. 48 p. (In Russ).
  5. Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. doi: 10.1016/S0140-6736(20)30251-8
  6. Cao W, Li T. COVID-19: towards understanding of pathogenesis. Cell Res. 2020;30(3):367–369. doi: 10.1038/s41422- 020-0327-4
  7. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271–280.e8. doi: 10.1016/j.cell.2020.02.052
  8. Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID-19). A review. JAMA. 2020;324(8):782–793. doi: 10.1001/jama.2020.12839
  9. Dalan R, Bornstein SR, El-Armouche A, et al. The ACE-2 in COVID-19: Foe or friend? Horm Metab Res. 2020;52(5): 257–263. doi: 10.1055/a-1155-0501
  10. Wölfel R, Corman VM, Guggemos W, еt al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020;581(7809):465–469. doi: 10.1038/s41586-020-2196-x
  11. Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med. 2020;382(17):e38. doi: 10.1056/NEJMc2007575
  12. Amdahl M. COVID-19: debunking the hemoglobin story [Internet]. Available from: https:/medium.com/@amdahl/ covid-19debunking-thehemoglobin-story-ce27773d1096
  13. Barton LM, Duval EJ, Stroberg E, et al. COVID-19 Autopsies, Oklahoma, USA. Am J Clin Pathol. 2020;153(6):725–733. doi: 10.1093/ AJCP/AQAA062
  14. Wichmann D, Sperhake J, Litgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med. 2020;173(4):268–277. doi: 10.7326/M20-2003
  15. Shoenfeld Y. Corona (COVID-19) time musings: our involvement in COVID-19 pathogenesis, diagnosis, treatment and vaccine planning. Autoimmun Rev. 2020;19(6):102538. doi: 10.1016/j.autrev.2020.102538
  16. Zayratyants OV, Samsonova MV, Mikhaleva LM, et al. Pathological anatomy of the lungs in COVID-19. Atlas. Ed. by O.V. Zayratyants. Moscow-Ryazan: Ryazanskaya oblastnaya tipografiya; 2020. 52 p. (In Russ).
  17. Zayratyants OV, Samsonova MV, Mikhaleva LM, et al. Pathological anatomy COVID-19. Atlas. Ed. by O.V. Zayratyants. Moscow; 2020. 140 p. (In Russ).
  18. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4): 844–847. doi: 10.1111/jth.14768
  19. Zheng M, Gao Y, Wang G, et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol. 2020;17(5):533–535. doi: 10.1038/s41423-020-0402-2
  20. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762–768. doi: 10.1093/ cid/ciaa248
  21. Lin L, Lu L, Cao W, Li T. Hypothesis for potential pathogenesis of SARS-CoV-2 infection — a review of immune changes in patients with viral pneumonia. Emerg Microbes Infect. 2020;9(1):727–732. doi: 10.1080/22221751.2020.1746199
  22. O’Donnell R, Tasker RC, Roe MF. SARS: understanding the coronavirus. BMJ. 2003;327(7415):620. doi: 10.1136/bmj.327.7415.620-b
  23. Varga S, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in CoVID-19. Lancet. 2020;395(10234): 1417–1418. doi: 10.1016/S0140-6736(20)30937-5
  24. Zinserling VА, Vashukova МА, Vasilyeva МV, et al. Issues of pathology of a new coronavirus infection COVID-19. Jurnal Infektologii. 2020;12(2):5–11. (In Russ). doi: 10.22625/ 2072-6732-2020-12-2-5-11
  25. Society of Pathological Doctors Chinese Medical Doctors Association; Chinese Society of Pathology; Chinese Medical Association. [Provisional guidelines on autopsy practice for deaths associated with COVID-19. (In Chinese.)]. Zhonghua Bing Li Xue Za Zhi. 2020;49(5):406–410. doi: 10.3760/cma.j.cn112151-20200309-00184
  26. Liu Q, Wang RS, Qu GQ, et al. Gross examination report of a COVID-19 death autopsy. Fa Yi Xue Za Zhi. 2020;36(1):21–23. doi: 10.12116/j.issn.1004-5619.2020.01.005
  27. Petrosillo N, Viceconte G, Ergonul O, et al. COVID-19, SARS and MERS: are they closely related? Clin Microbiol Infect. 2020;26(6):729–734. doi: 10.1016/j.cmi.2020.03.026
  28. Yao XH, Li TY, He ZC, et al. [A pathological report of three COVID-19 cases by minimally invasive autopsies. (In Chinese)]. Zhonghua Bing Li Xue Za Zhi. 2020;49(5):411–417. doi: 10.3760/cma.j.cn112151-20200312-00193
  29. Baig AM, Khalleed A, Ali U, Syeda H. Evidence of COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020;11(7):995–998. doi: 10.1021/acschemneuro.0c00122
  30. Chen XB, Du SH, Lu JC, et al. Retrospective analysis of 61 cases of children died of viral pneumonia. Fa Yi Xue Za Zhi. 2020;36(2):164–168. doi: 10.12116/j.issn.1004-5619. 2020.02.002
  31. Fox SE, Akmatbekov A, Harbert JL, et al. Pulmonary and cardical pathology in African American patients with COVID-19: an autopsy series from New Orlean. Lancet Respir Med. 2020; 8(7):681–686. doi: 10.1016/S2213-2600(20)30243-5
  32. Su H, Yang M, Wan C, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020;98(1):219–227. doi: 10.1016/j.kint.2020.04.003
  33. Xu Z, Sh L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420–422. doi: 10.1016/S2213-2600(20)30076-X
  34. Zairatyants OV, Chernyaev AL, Chuchalin AG, et al. Pathomorphology of the lung in severe influenza A/H1N1 [Patomorfologiya legkikh pri tyazheloi forme grippa A(H1N1)]. Russian journal of anaesthesiology and reanimatology. 2010;(3): 25–29. (In Russ).
  35. Chernyaev AL, Zayratyants OV, Polyanko NI, et al. Pathological anatomy of influenza A/H1N1 [Patologicheskaya anatomiya grippa A/H1N1]. Archive of Pathology. 2010;72(3):3–6. (In Russ).
  36. Chuchalin AG, Chernyaev AL, Zairatyants OV, et al. Pathological anatomy of the lungs in influenza A (H1N1) according to autopsies [Patologicheskaya anatomiya legkikh pri grippe A(H1N1) po dannym autopsii]. Pulmonology. 2010;(1):5–11. (In Russ).
  37. Zabozlaev FG, Kravchenko EV, Gallyamova AR, Letunovsky NN. Pulmonary pathology of the new coronavirus disease (COVID-19). The preliminary analysis of post-mortem findings. Journal of Clinical Practice. 2020;11(2):21–37. (In Russ). doi: 10.17816/ clinpract34849

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