Autopsy findings in COVID-19-related deaths in forensic practice - analysis of 184 cases

COVID-19, caused by the SARS-CoV-2 virus, has posed a  major burden on both healthcare systems and society, while autopsies provide insight into the mechanisms of death, the extent of organ involvement, and the true contribution of infection to mortality. We retrospectively analyzed documentation from 184 deceased individuals who underwent autopsy at the Department of Forensic Medicine and Medical Law in Olomouc and in whom COVID-19 represented the immediate or a significantly contributing cause of death. Demographic data, comorbidities, and autopsy findings were evaluated, and in a subgroup of 16 cases fat embolism was assessed and compared with 16 COVID-negative controls. The cohort was dominated by older males, most of whom had overweight or obesity and a high prevalence of cardiometabolic comorbidities, particularly hypertension, ischemic heart disease, and diabetes. The most frequent immediate cause of death was viral pneumonia with acute respiratory failure and a pattern of diffuse alveolar damage, followed by congestive heart failure and pulmonary thromboembolism; bacterial superinfection was present only in a subset of cases. Pulmonary fat embolism was detected in the majority of examined COVIDpositive individuals, often with systemic dissemination independent of BMI. The autopsy findings confirm that COVID-19 is a  systemic viral disease with predominant pulmonary involvement, significant thromboembolic complications, and a  key role of forensic autopsies in accurately determining causes of death and understanding the disease pathogenesis.