AUTHOR=Ruiz-Cáceres Inmaculada , Hermida Romero Teresa , Guerra Merino Isabel , Portu Zapirain Joseba , Pérez-Mies Belén , Sánchez-Conde Matilde , Riaño Marina Alonso , Rubio Rafael , Fortés Alen Jose , Vidal González Ánxela , Salas Antón Clara , Múñez Elena , Sánchez Sánchez Rafael , Corona-Mata Diana , Aldecoa Ansorregui Iban , Miró José M. , Beloqui Pérez de Obanos Raquel , Ibero Carlos , Gómez-Román Javier , Fariñas M. Carmen , Tabuyo Bello Teresa , de Alava Enrique , Cisneros José Miguel , Matías-Guiu Xavier , Rivero Antonio , on behalf of the NECROCOVID Study Group TITLE=Post-mortem findings in Spanish patients with COVID-19; a special focus on superinfections JOURNAL=Frontiers in Medicine VOLUME=10 YEAR=2023 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1151843 DOI=10.3389/fmed.2023.1151843 ISSN=2296-858X ABSTRACT=Introduction

Whole-body autopsies may be crucial to understand coronavirus disease 2019 (COVID-19) pathophysiology. We aimed to analyze pathological findings in a large series of full-body autopsies, with a special focus on superinfections.

Methods

This was a prospective multicenter study that included 70 COVID-19 autopsies performed between April 2020 and February 2021. Epidemiological, clinical and pathological information was collected using a standardized case report form.

Results

Median (IQR) age was 70 (range 63.75–74.25) years and 76% of cases were males. Most patients (90%,) had at least one comorbidity prior to COVID-19 diagnosis, with vascular risk factors being the most frequent. Infectious complications were developed by 65.71% of the patients during their follow-up. Mechanical ventilation was required in most patients (75.71%) and was mainly invasive. In multivariate analyses, length of hospital stay and invasive mechanical ventilation were significantly associated with infections (p = 0.036 and p = 0.013, respectively). Necropsy findings revealed diffuse alveolar damage in the lungs, left ventricular hypertrophy in the heart, liver steatosis and pre-infection arteriosclerosis in the heart and kidneys.

Conclusion

Our study confirms the main necropsy histopathological findings attributed to COVID-19 in a large patient series, while underlining the importance of both comorbid conditions and superinfections in the pathology.