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Pathology and Laboratory Medicine

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

JAMA

Published Online: May 21, 2020

Research Letter

Article Information and Disclosures

Tina Schaller, MD¹;

Klaus Hirschbühl, MD²;

Katrin Burkhardt, MD³;

Author Affiliations

¹Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, Augsburg, Germany
²Department of Hematology and Clinical Oncology, University Medical Center Augsburg, Augsburg, Germany
³Institute of Laboratory Medicine and Microbiology, University Medical Center Augsburg, Augsburg, Germany
⁴Department of Gastroenterology, University Medical Center Augsburg, Augsburg, Germany

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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

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)30183-5 PubMed Google Scholar Crossref

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.2020.1585 PubMed Google Scholar

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-2020-206522 PubMed Google Scholar Crossref

Gu J , Korteweg C . Pathology and pathogenesis of severe acute respiratory syndrome. Am J Pathol. 2007;170(4):1136-1147. doi:10.2353/ajpath.2007.061088 PubMed Google Scholar Crossref

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.4458 PubMed Google Scholar Crossref

Postmortem Examination of Patients With COVID-19

Characteristics and Outcomes of Critically Ill Patients With COVID-19 in Washington State

Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China

Renin-Angiotensin System Inhibitors and Severity or Risk of Death in Patients With Hypertension Hospitalized for COVID-19

Clinical Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in the NYC Area

Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs

Treatment With Hydroxychloroquine or Azithromycin and In-Hospital Mortality in Patients With COVID-19

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