Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany
Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany
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DOI：
10.1007/s00414-020-02317-w
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发表时间：
2020-06-04
影响因子：
2.1
通讯作者：
Sperhake, Jan-Peter
中科院分区：
文献类型：
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作者：
Edler, Carolin;Schroeder, Ann Sophie;Sperhake, Jan-Peter
对确诊为严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染的死者进行尸检可以为了解这种新型疾病及其病程提供重要信息。此外，尸检对于正确统计2019冠状病毒病（COVID-19）死亡人数至关重要。在北方德国联邦汉堡州，自德国爆发大流行以来，所有死亡的汉堡公民在生前或死后经PCR证实的SARS-CoV-2感染都进行了尸检。我们的评估提供了前80个连续完整尸检的系统概述。提出了对SARS-CoV-2感染死亡进行分类的建议（第1类：明确的COVID-19死亡;第2类：可能的COVID-19死亡;第3类：可能的COVID-19死亡，但有相同的其他死因;第4类：检测到SARS-CoV-2，但死因与COVID-19无关）。在6例病例中，SARS-CoV-2感染是通过鼻咽或肺组织拭子中的阳性PCR检测在死后诊断的。在其他74例病例中，SARS-CoV-2感染在死前就已经知道了。死者年龄在52岁至96岁之间（平均79.2岁，中位数82.4岁）。在研究队列中，34名死亡者为女性（38%），46名男性（62%）。总体而言，38%的死者超重或肥胖。除两名女性（尸检未发现明显的既存疾病）外，所有死者均患有相关合并症（按频率降序排列）：（1）心血管系统疾病，（2）肺部疾病，（3）中枢神经系统疾病，（4）肾脏疾病，和（5）糖尿病。共有76例（95%）被归类为COVID-19死亡，对应于1-3类。4例死亡（5%）被定义为非COVID-19死亡，死亡原因与病毒无关。在8例病例中，肺炎合并暴发性肺动脉栓塞。在其他9例病例中发现了外周肺动脉栓塞。总体而言，40%的病例中发现了深静脉血栓形成。这项研究提供了迄今为止对SARS-CoV-2感染患者尸检的最大概述。
Autopsies of deceased with a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide important insights into the novel disease and its course. Furthermore, autopsies are essential for the correct statistical recording of the coronavirus disease 2019 (COVID-19) deaths. In the northern German Federal State of Hamburg, all deaths of Hamburg citizens with ante- or postmortem PCR-confirmed SARS-CoV-2 infection have been autopsied since the outbreak of the pandemic in Germany. Our evaluation provides a systematic overview of the first 80 consecutive full autopsies. A proposal for the categorisation of deaths with SARS-CoV-2 infection is presented (category 1: definite COVID-19 death; category 2: probable COVID-19 death; category 3: possible COVID-19 death with an equal alternative cause of death; category 4: SARS-CoV-2 detection with cause of death not associated to COVID-19). In six cases, SARS-CoV-2 infection was diagnosed postmortem by a positive PCR test in a nasopharyngeal or lung tissue swab. In the other 74 cases, SARS-CoV-2 infection had already been known antemortem. The deceased were aged between 52 and 96 years (average 79.2 years, median 82.4 years). In the study cohort, 34 deceased were female (38%) and 46 male (62%). Overall, 38% of the deceased were overweight or obese. All deceased, except for two women, in whom no significant pre-existing conditions were found autoptically, had relevant comorbidities (in descending order of frequency): (1) diseases of the cardiovascular system, (2) lung diseases, (3) central nervous system diseases, (4) kidney diseases, and (5) diabetes mellitus. A total of 76 cases (95%) were classified as COVID-19 deaths, corresponding to categories 1-3. Four deaths (5%) were defined as non-COVID-19 deaths with virus-independent causes of death. In eight cases, pneumonia was combined with a fulminant pulmonary artery embolism. Peripheral pulmonary artery embolisms were found in nine other cases. Overall, deep vein thrombosis has been found in 40% of the cases. This study provides the largest overview of autopsies of SARS-CoV-2-infected patients presented so far.