What can autopsy say about COVID-19? A case series of 60 autopsies

Introduction: Autopsies in SARS-CoV-2 infected cadavers are mainly performed to distinguish patients who died\r\nwith SARS-CoV-2 infection from those who died of COVID-19. The aim of the current study is to assess the most\r\nfrequent autopsy findings in patients who died of COVID-19 and to establish an association with clinical records.\r\nMaterials and methods: 60 patients died between April 2020 and March 2021 after SARS-CoV-2 infection underwent a full autopsy performed at Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome). Antemortem diagnosis of SARS-CoV-2 infection was microbiologically confirmed.\r\nResults: 55 (92%) of cases had at least a comorbidity. At microscopic examination, 40 (67%) of the patients\r\npresented pulmonary intravascular coagulation with an inflammatory pattern. Pulmonary microangiopathy was\r\na rare finding (n = 8; 13%). Myocardiosclerosis was the main heart finding (n = 44; 73%). Liver involvement\r\nwith congestion and hypotrophy was found in 33 (55%) of cadavers. Renal tubular epithelial exfoliation (n = 12;\r\n20%) and intravascular coagulation (n = 4; 7%) were frequent observations. During hospitalization 31% of\r\npatients (n = 19) developed acute kidney injury (AKI).\r\nConclusions: Lungs and kidneys have been shown to play a pivotal role in COVID-19. The gradual worsening of\r\nrenal function and AKI might be the result of the progressive collapse of cardiopulmonary system.