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Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany.
Int J Legal Med. 2020 Jul; 134(4):1275-1284.IJ

Abstract

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.

Authors+Show Affiliations

Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Institute of Microbiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany. sperhake@uke.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32500199

Citation

Edler, Carolin, et al. "Dying With SARS-CoV-2 Infection-an Autopsy Study of the First Consecutive 80 Cases in Hamburg, Germany." International Journal of Legal Medicine, vol. 134, no. 4, 2020, pp. 1275-1284.
Edler C, Schröder AS, Aepfelbacher M, et al. Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany. Int J Legal Med. 2020;134(4):1275-1284.
Edler, C., Schröder, A. S., Aepfelbacher, M., Fitzek, A., Heinemann, A., Heinrich, F., Klein, A., Langenwalder, F., Lütgehetmann, M., Meiβner, K., Püschel, K., Schädler, J., Steurer, S., Mushumba, H., & Sperhake, J. P. (2020). Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany. International Journal of Legal Medicine, 134(4), 1275-1284. https://doi.org/10.1007/s00414-020-02317-w
Edler C, et al. Dying With SARS-CoV-2 Infection-an Autopsy Study of the First Consecutive 80 Cases in Hamburg, Germany. Int J Legal Med. 2020;134(4):1275-1284. PubMed PMID: 32500199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany. AU - Edler,Carolin, AU - Schröder,Ann Sophie, AU - Aepfelbacher,Martin, AU - Fitzek,Antonia, AU - Heinemann,Axel, AU - Heinrich,Fabian, AU - Klein,Anke, AU - Langenwalder,Felicia, AU - Lütgehetmann,Marc, AU - Meiβner,Kira, AU - Püschel,Klaus, AU - Schädler,Julia, AU - Steurer,Stefan, AU - Mushumba,Herbert, AU - Sperhake,Jan-Peter, Y1 - 2020/06/04/ PY - 2020/05/01/received PY - 2020/05/15/accepted PY - 2020/6/6/pubmed PY - 2020/7/1/medline PY - 2020/6/6/entrez KW - Autopsy KW - COVID-19 KW - Coronavirus KW - Pulmonary embolism KW - SARS-CoV-2 KW - Venous thromboembolic disease SP - 1275 EP - 1284 JF - International journal of legal medicine JO - Int. J. Legal Med. VL - 134 IS - 4 N2 - 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. SN - 1437-1596 UR - https://www.unboundmedicine.com/medline/citation/32500199/Dying_with_SARS_CoV_2_infection_an_autopsy_study_of_the_first_consecutive_80_cases_in_Hamburg_Germany_ L2 - https://dx.doi.org/10.1007/s00414-020-02317-w DB - PRIME DP - Unbound Medicine ER -