Postmortem Findings Associated With SARS-CoV-2: Systematic Review and Meta-analysis.
Level 4 - case-series / case-control
Systematic review and meta-analysis of postmortem case series.
PubMed 33481385 · doi:10.1097/PAS.0000000000001650
What was done
The authors conducted a systematic review and meta-analysis comparing postmortem pathology findings between COVID-19 (n=241 patients, median age 70 years) and SARS-CoV-1 deaths (n=91 patients, median age 50 years), pooling data from published articles and preprints.
What was found
Diffuse alveolar damage (DAD) was significantly less common in COVID-19 autopsies (80.9%) than in SARS-CoV-1 autopsies (100.0%, P = 0.001). Extrapulmonary findings were generally comparable, though hepatic necrosis (P < 0.001), splenic necrosis (P < 0.006), and splenic white pulp depletion (P < 0.001) were significantly more frequent in SARS-CoV-1. Reported COVID-19 postmortem findings also included pulmonary hemorrhage, viral cytopathic effects in pneumocytes, thromboembolism, brain infarction, endotheliitis, acute renal tubular damage, cardiac myocyte necrosis, megakaryocyte recruitment, and hemophagocytosis.
Why it matters
This study summarizes early global histopathologic autopsy data from COVID-19 fatalities, highlighting pulmonary DAD alongside widespread microvascular and thrombotic involvement across multiple organ systems.
Limits
The included literature relies on early case series and non-peer-reviewed preprints. Cohorts differed substantially in median age (70 years for COVID-19 vs. 50 years for SARS-CoV-1), confounding direct comparisons, and the abstract does not report the total number of studies included or adjust for baseline patient comorbidities.
Cited by
- supports Neuropathological evaluations of COVID-19 patient brains show microthrombosis, microhemorrhage, inflammatory cells, and megakaryocytes.