A Postmortem Portrait of the Coronavirus Disease 2019 (COVID-19) Pandemic: A Large Multi-institutional Autopsy Survey Study
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- Jody E. Hooper
- The Department of Pathology, Johns Hopkins University, Baltimore, Maryland (Hooper)
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- Robert F. Padera
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Padera Jr, Gawelek, Solomon)
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- Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
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- Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
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- Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
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- Meghan E. Kapp
- The Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Kapp)
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- J. Matthew Lacy
- Snohomish County Medical Examiner's Office, Everett, Washington (Lacy)
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- Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
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- Paulo Hilario Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Dolhnikoff, Ferraz da Silva, Nunes Duarte-Neto, Mauad, Nascimento Saldiva, de Almeida Monteiro)
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- Amy V. Rapkiewicz
- The Department of Pathology, NYU Long Island School of Medicine, Mineola, New York (Rapkiewicz)
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- Dwayne A. Wolf
- Harris County Institute of Forensic Sciences, Houston, Texas (Wolf)
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- Juan C. Felix
- The Department of Pathology, Medical College of Wisconsin, Milwaukee (Felix)
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- Paul Benson
- The Department of Pathology, University of Alabama at Birmingham, Birmingham (Benson, Litovsky, Reilly)
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- Elisheva Shanes
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
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- Kara L. Gawelek
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Padera Jr, Gawelek, Solomon)
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- Desiree A. Marshall
- The Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Marshall)
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- Michelle M. McDonald
- The Department of Pathology & Laboratory Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Houston (McDonald, Bhattacharjee, Zhao)
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- William Muller
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
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- David S. Priemer
- The Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Priemer)
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- Isaac H. Solomon
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Padera Jr, Gawelek, Solomon)
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- Taylor Zak
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
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- Meenakshi B. Bhattacharjee
- The Department of Pathology & Laboratory Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Houston (McDonald, Bhattacharjee, Zhao)
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- Lucy Fu
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
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- Andrea R. Gilbert
- The Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, Long School of Medicine, San Antonio (Gilbert)
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- Holly L. Harper
- The Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Harper)
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- Silvio Litovsky
- The Department of Pathology, University of Alabama at Birmingham, Birmingham (Benson, Litovsky, Reilly)
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- Jon Lomasney
- The Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Shanes, Muller, Zak, Fu, Lomasney)
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- Sharon L. Mount
- The Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Mount, Threlkeld)
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- Stephanie Reilly
- The Department of Pathology, University of Alabama at Birmingham, Birmingham (Benson, Litovsky, Reilly)
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- Miroslav Sekulic
- The Department of Pathology and Cell Biology, Columbia University, New York, New York (Sekulic)
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- Thora S. Steffensen
- The Department of Pathology, Tampa General Hospital, Tampa, Florida (Steffensen)
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- Kirsten J. Threlkeld
- The Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Mount, Threlkeld)
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- Bihong Zhao
- The Department of Pathology & Laboratory Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Houston (McDonald, Bhattacharjee, Zhao)
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- Alex K. Williamson
- The Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Williamson)
説明
<jats:sec> <jats:title>Context.—</jats:title> <jats:p>This study represents the largest compilation to date of clinical and postmortem data from decedents with coronavirus disease 2019 (COVID-19). It will augment previously published small series of autopsy case reports, refine clinicopathologic considerations, and improve the accuracy of future vital statistical reporting.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective.—</jats:title> <jats:p>To accurately reflect the preexisting diseases and pathologic conditions of decedents with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection through autopsy.</jats:p> </jats:sec> <jats:sec> <jats:title>Design.—</jats:title> <jats:p>Comprehensive data from 135 autopsy evaluations of COVID-19–positive decedents is presented, including histologic assessment. Postmortem examinations were performed by 36 pathologists at 19 medical centers or forensic institutions in the United States and Brazil. Data from each autopsy were collected through the online submission of multiple-choice and open-ended survey responses.</jats:p> </jats:sec> <jats:sec> <jats:title>Results.—</jats:title> <jats:p>Patients dying of or with COVID-19 had an average of 8.89 pathologic conditions documented at autopsy, spanning a combination of prior chronic disease and acute conditions acquired during hospitalization. Virtually all decedents were cited as having more than 1 preexisting condition, encompassing an average of 2.88 such diseases each. Clinical conditions during terminal hospitalization were cited 395 times for the 135 autopsied decedents and predominantly encompassed acute failure of multiple organ systems and/or impaired coagulation. Myocarditis was rarely cited.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions.—</jats:title> <jats:p>Cause-of-death statements in both autopsy reports and death certificates may not encompass the severity or spectrum of comorbid conditions in those dying of or with COVID-19. If supported by additional research, this finding may have implications for public health decisions and reporting moving forward through the pandemic.</jats:p> </jats:sec>
収録刊行物
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- Archives of Pathology & Laboratory Medicine
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Archives of Pathology & Laboratory Medicine 145 (5), 529-535, 2021-01-15
Archives of Pathology and Laboratory Medicine