Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome : Results From a Prospective, Single-Center,...

Area of Science:

• Pathology
• Pulmonology
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has led to a global pandemic with significant mortality.
• Understanding the pathological changes and clinicopathological basis of severe and fatal COVID-19 outcomes is crucial.

Purpose of the Study:

• To evaluate the pathological changes in organ systems of patients deceased from COVID-19.
• To determine the clinicopathological basis for severe and fatal outcomes in COVID-19.

Main Methods:

• A prospective autopsy study was conducted at a single pathology department.
• Systematic macroscopic, histopathologic, and viral analysis (SARS-CoV-2 RNA) was performed on 10 of 11 deceased COVID-19 patients.
• Pathologic findings were correlated with clinical features, comorbidities, comedication, and laboratory values.

Main Results:

• All 11 patients exhibited diffuse alveolar damage (DAD) in the lungs, with thrombosis of small and mid-sized pulmonary arteries found in all cases, leading to infarction in 8.
• Kupffer cell proliferation and chronic hepatic congestion were observed in all patients, along with other liver, kidney, adrenal, spleen, and lymph node abnormalities.
• SARS-CoV-2 RNA was detectable in pharyngeal, bronchial, and colonic mucosa.

Conclusions:

• COVID-19 primarily affects the lungs, causing DAD and respiratory failure.
• Pulmonary artery thrombosis, even with prophylactic anticoagulation, can contribute to mortality in COVID-19.
• Further research is needed on thrombotic complications, optimal thrombosis prophylaxis, and early anticoagulant therapy for pulmonary arterial thrombosis in COVID-19.