Abstract
Despite safety recommendations for the management of corpses with COVID-19 infection and the high number of deaths worldwide, the post-mortem investigation rate is extremely low as well as the scientific contributions describing the pathological features. The first results of post-mortem investigations provided interesting findings and contributed to promoting unexplored therapeutic approaches and new frontiers of research. A systematic review is provided with the aim of summarizing all autopsy studies up to February 2020 in which a complete post-mortem investigation in patients with COVID-19 disease was performed, focusing on histopathological features. We included case reports, case series, retrospective and prospective studies, letters to the editor, and reviews. A total of 28 studies fulfilled the inclusion criteria, producing a pooled dataset of 407 full autopsies. Analyzing the medical history data, only 12 subjects had died without any comorbidities (for 15 cases the data were not available). The post-mortem investigation highlighted that acute respiratory distress syndrome (ARDS) and multiple organ failure represent the main clinical features of COVID-19 disease, often leading to pulmonary thromboembolism and superimposed bronchopneumonia. The discussed data showed a strict relationship among the inflammatory processes, diffuse alveolar, and endothelial damage. In light of these results, the full autopsy can be considered as the gold standard to investigate unknown infections or pathogens resulting in death.
Highlights
Despite the fact that the COVID-19 infection is still ongoing in different countries worldwide, authorities and institutions are still limiting or avoiding autopsies of subjects who died from/withCOVID-19 because of the possible biological hazards to personnel [1]
The limited number of full autopsies and published papers may represent a limitation to the statistical value of the morphological findings and overestimating the significance of pathological features may become a risk
This study identified 32 papers reporting experiences with 407 full autopsies in COVID-19-related death
Summary
Despite the fact that the COVID-19 infection is still ongoing in different countries worldwide, authorities and institutions are still limiting or avoiding autopsies of subjects who died from/withCOVID-19 because of the possible biological hazards to personnel [1]. To improve safety in the management of cadavers confirmed or suspected of COVID-19 disease, scientific societies have provided guidelines and recommendations including safety measures for the safe and effective performance of HGC3 autopsy investigations (personnel protective equipment, negative-pressure autopsy rooms and limitations for operators) [2,3,4,5,6,7,8,9]. It would have been sufficient to call for better and safer autopsies to clarify the full extent of organ involvement associated with COVID-19 [15] The absence of post-mortem investigations has failed to provide a valuable contribution to the correct management and treatment of patients, in the first phase of the unknown infection. The limited number of autopsies did not establish the correct mortality rate of COVID-19 and did not define the statistical relevance of pathological findings, the risk of overestimation of pathologic features cannot be excluded
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