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Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study

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Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. / Wichmann, Dominic; Sperhake, Jan-Peter; Lütgehetmann, Marc; Steurer, Stefan; Edler, Carolin; Heinemann, Axel; Heinrich, Fabian; Mushumba, Herbert; Kniep, Inga; Schröder, Ann Sophie; Burdelski, Christoph; de Heer, Geraldine; Nierhaus, Axel; Frings, Daniel; Pfefferle, Susanne; Becker, Heinrich; Bredereke-Wiedling, Hanns; de Weerth, Andreas; Paschen, Hans-Richard; Sheikhzadeh-Eggers, Sara; Stang, Axel; Schmiedel, Stefan; Bokemeyer, Carsten; Addo, Marylyn M; Aepfelbacher, Martin; Püschel, Klaus; Kluge, Stefan.

In: ANN INTERN MED, Vol. 173, No. 4, 18.08.2020, p. 268-277.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Wichmann, D, Sperhake, J-P, Lütgehetmann, M, Steurer, S, Edler, C, Heinemann, A, Heinrich, F, Mushumba, H, Kniep, I, Schröder, AS, Burdelski, C, de Heer, G, Nierhaus, A, Frings, D, Pfefferle, S, Becker, H, Bredereke-Wiedling, H, de Weerth, A, Paschen, H-R, Sheikhzadeh-Eggers, S, Stang, A, Schmiedel, S, Bokemeyer, C, Addo, MM, Aepfelbacher, M, Püschel, K & Kluge, S 2020, 'Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study', ANN INTERN MED, vol. 173, no. 4, pp. 268-277. https://doi.org/10.7326/M20-2003

APA

Wichmann, D., Sperhake, J-P., Lütgehetmann, M., Steurer, S., Edler, C., Heinemann, A., Heinrich, F., Mushumba, H., Kniep, I., Schröder, A. S., Burdelski, C., de Heer, G., Nierhaus, A., Frings, D., Pfefferle, S., Becker, H., Bredereke-Wiedling, H., de Weerth, A., Paschen, H-R., ... Kluge, S. (2020). Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. ANN INTERN MED, 173(4), 268-277. https://doi.org/10.7326/M20-2003

Vancouver

Wichmann D, Sperhake J-P, Lütgehetmann M, Steurer S, Edler C, Heinemann A et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. ANN INTERN MED. 2020 Aug 18;173(4):268-277. https://doi.org/10.7326/M20-2003

Bibtex

@article{af2fdc7daef44db69ae312d23c31cba4,
title = "Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study",
abstract = "Background: The new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features.Objective: To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests.Design: Prospective cohort study.Setting: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction-confirmed diagnosis of COVID-19.Patients: The first 12 consecutive COVID-19-positive deaths.Measurements: Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. Results: Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital (n = 10) or outpatient sector (n = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem 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 lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart.Limitation: Limited sample size.Conclusion: The high incidence of thromboembolic events suggests an important role of COVID-19-induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19-related death, as well as possible therapeutic interventions to reduce it.Primary Funding Source: University Medical Center Hamburg-Eppendorf.",
author = "Dominic Wichmann and Jan-Peter Sperhake and Marc L{\"u}tgehetmann and Stefan Steurer and Carolin Edler and Axel Heinemann and Fabian Heinrich and Herbert Mushumba and Inga Kniep and Schr{\"o}der, {Ann Sophie} and Christoph Burdelski and {de Heer}, Geraldine and Axel Nierhaus and Daniel Frings and Susanne Pfefferle and Heinrich Becker and Hanns Bredereke-Wiedling and {de Weerth}, Andreas and Hans-Richard Paschen and Sara Sheikhzadeh-Eggers and Axel Stang and Stefan Schmiedel and Carsten Bokemeyer and Addo, {Marylyn M} and Martin Aepfelbacher and Klaus P{\"u}schel and Stefan Kluge",
year = "2020",
month = aug,
day = "18",
doi = "10.7326/M20-2003",
language = "English",
volume = "173",
pages = "268--277",
journal = "ANN INTERN MED",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "4",

}

RIS

TY - JOUR

T1 - Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study

AU - Wichmann, Dominic

AU - Sperhake, Jan-Peter

AU - Lütgehetmann, Marc

AU - Steurer, Stefan

AU - Edler, Carolin

AU - Heinemann, Axel

AU - Heinrich, Fabian

AU - Mushumba, Herbert

AU - Kniep, Inga

AU - Schröder, Ann Sophie

AU - Burdelski, Christoph

AU - de Heer, Geraldine

AU - Nierhaus, Axel

AU - Frings, Daniel

AU - Pfefferle, Susanne

AU - Becker, Heinrich

AU - Bredereke-Wiedling, Hanns

AU - de Weerth, Andreas

AU - Paschen, Hans-Richard

AU - Sheikhzadeh-Eggers, Sara

AU - Stang, Axel

AU - Schmiedel, Stefan

AU - Bokemeyer, Carsten

AU - Addo, Marylyn M

AU - Aepfelbacher, Martin

AU - Püschel, Klaus

AU - Kluge, Stefan

PY - 2020/8/18

Y1 - 2020/8/18

N2 - Background: The new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features.Objective: To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests.Design: Prospective cohort study.Setting: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction-confirmed diagnosis of COVID-19.Patients: The first 12 consecutive COVID-19-positive deaths.Measurements: Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. Results: Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital (n = 10) or outpatient sector (n = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem 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 lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart.Limitation: Limited sample size.Conclusion: The high incidence of thromboembolic events suggests an important role of COVID-19-induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19-related death, as well as possible therapeutic interventions to reduce it.Primary Funding Source: University Medical Center Hamburg-Eppendorf.

AB - Background: The new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features.Objective: To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests.Design: Prospective cohort study.Setting: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction-confirmed diagnosis of COVID-19.Patients: The first 12 consecutive COVID-19-positive deaths.Measurements: Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. Results: Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital (n = 10) or outpatient sector (n = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem 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 lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart.Limitation: Limited sample size.Conclusion: The high incidence of thromboembolic events suggests an important role of COVID-19-induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19-related death, as well as possible therapeutic interventions to reduce it.Primary Funding Source: University Medical Center Hamburg-Eppendorf.

U2 - 10.7326/M20-2003

DO - 10.7326/M20-2003

M3 - SCORING: Journal article

C2 - 32374815

VL - 173

SP - 268

EP - 277

JO - ANN INTERN MED

JF - ANN INTERN MED

SN - 0003-4819

IS - 4

ER -