A systematic review of autopsy findings in COVID 19: The road ahead

Abstract

Autopsy data on the COVID 19 is scarce and has left a gap in understanding the disease process. This study attempts to review the available data gleamed from the limited autopsies performed worldwide which would help in guiding future treatment protocols.A literature search was undertaken using PubMed, Scopus, Embase and Google search engines for original and review articles. Studies that mentioned autopsy and COVID-19 were included. Findings from a total of 16 studies mentioning 139 autopsies in confirmed cases of COVID 19 were analysed. The most common features in fatal cases has been cough followed by progressive dyspnoea. Fatal cases show a predominance in the elderly age group, male gender and individuals with blood type A.Autopsy findings in various organs have been described with the prominent feature being Diffuse alveolar damage and microthrombii formation in the lung. Massive pulmonary embolism and Deep vein thrombosis seem to be overlooked features in the fatal cases.Complement mediated destruction is a potential pathogenetic mechanism suggested by C4d and C5b-9 deposition in the skin lesions and lung capillaries.To conclude, Prophylactic dose of low molecular weight heparin, chest CT and serial D-dimer levels are recommended in all patients with suspected COVID 19 admitted to the hospital.The demonstration of complement mediated injury to various tissues also suggest a role of anti-complement therapy to improve patient outcomes.Detailed autopsy studies are required to evaluate the pathology of COVID 19 in various organs to understand the disease process better