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Postmortem Examination of Patients With COVID-19

Educational Objective
To understand what postmortem examination of 10 patients can tell us about COVID-19
1 Credit CME

Approximately 15% of individuals affected by coronavirus disease 2019 (COVID-19) develop severe disease, and 5% to 6% are critically ill (respiratory failure and/or multiple organ dysfunction or failure).1,2 Severely ill and critically ill patients have a high mortality rate, especially with older age and coexisting medical conditions. Because there are still insufficient data on cause of death, we describe postmortem examinations in a case series of patients with COVID-19.

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Article Information

Accepted for Publication: May 11, 2020.

Corresponding Author: Rainer Claus, MD, Department of Hematology and Clinical Oncology, University Medical Center Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany (rainer.claus@uk-augsburg.de).

Published Online: May 21, 2020. doi:10.1001/jama.2020.8907

Author Contributions: Drs Schaller and Claus had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Schaller and Hirschbühl contributed equally as first authors. Drs Märkl and Claus contributed equally as senior authors.

Concept and design: Schaller, Hirschbühl, Braun, Trepel, Märkl, Claus.

Acquisition, analysis, or interpretation of data: Schaller, Hirschbühl, Burkhardt, Märkl, Claus.

Drafting of the manuscript: Schaller, Hirschbühl, Braun, Trepel, Märkl, Claus.

Critical revision of the manuscript for important intellectual content: Schaller, Hirschbühl, Burkhardt, Trepel, Märkl, Claus.

Statistical analysis: Claus.

Obtained funding: Braun.

Administrative, technical, or material support: Schaller, Hirschbühl, Burkhardt, Trepel, Märkl.

Supervision: Claus.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the physicians from the intensive care unit (Michael Wittmann, MD, and Ulrich Jaschinski, MD), and the Department of Radiology (Thomas Kröncke, MD) of the University Medical Center Augsburg. We thank Jürgen Schlegel, MD, from the Department of Neuropathology, School of Medicine, Institute of Pathology, Technical University Munich, for sampling brain tissue. Technical support was provided by Alexandra Martin, AMLT, Christian Beul, AMLT, and Elfriede Schwarz, AMLT, from the Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg. No compensation was received for their roles in the study.

References
1.
Huang  C , Wang  Y , Li  X ,  et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.   Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5PubMedGoogle ScholarCrossref
2.
Wang  D , Hu  B , Hu  C ,  et al.  Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.   JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585PubMedGoogle Scholar
3.
Hanley  B , Lucas  SB , Youd  E , Swift  B , Osborn  M .  Autopsy in suspected COVID-19 cases.   J Clin Pathol. 2020;73(5):239-242. doi:10.1136/jclinpath-2020-206522PubMedGoogle ScholarCrossref
4.
Gu  J , Korteweg  C .  Pathology and pathogenesis of severe acute respiratory syndrome.   Am J Pathol. 2007;170(4):1136-1147. doi:10.2353/ajpath.2007.061088PubMedGoogle ScholarCrossref
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van den Brand  JM , Smits  SL , Haagmans  BL .  Pathogenesis of Middle East respiratory syndrome coronavirus.   J Pathol. 2015;235(2):175-184. doi:10.1002/path.4458PubMedGoogle ScholarCrossref
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